| ObjectiveCryptorchidism or undescended testes is a common disease in children. The main reason for treatment of undescended testes is increased infertility. Despite multiple studies, fertility in cryptorchidism child is still an uncertain issue. The aim of this study was to estimate fertility function after orchidopexy for unilateral or bilateral cryptorchidism with fertility rate, semen analysis (sperm concentration, motility and morphology), testicular volume, sexual function and physical examination. We are supposed to acquire more insight into the disease through analyzing the factors influencing the fertility after orchidopexy.MethodsThree hundred and forty two patients (237for unilateral cryptorchidism and105for bilateral cryptorchidism) who underwent orchidopexy in Shandong Provincial Hospital Affiliated to Shandong University between1981and1997were invited to participate in this study via mail, telephone or a visit. Fertility potential was estimated with paternity for married men and semen analysis for all unmarried subjects, and testicular volume and sexual function of all subjects were analyzed.Result49(14.3%) accepted the invitation and fulfilled the inclusion criteria. Sixteen had been operated upon for bilateral and thirty three for unilateral undescended testes. The average age of the subjects was26.9years (from19to36years), and their average age at orchidopexy was5.5years (from1.6to11years).1. Fertility rate and mean time to conception Fertility rate in married men of unilateral group was92.9%, and the mean time to conception was3months. But they were worse in subjects with bilateral orchidopexy. Fertility rate in married men was37.5%, and the mean time to conception of them was6.3months. So, the fertility rate of subjects with bilateral orchidopexy had significantly decreased (P=0.011) compared to subjects with unilateral orchidopexy. Among all the infertile subjects,3men (one with unilateral orchidopexy and two with bilateral orchidopexy) get the paternity after drug therapy.2. Semen analysis Among the unmarried subjects,17(89.5%)semen analysis were normal in unilateral group while it was2(25%) in bilateral group, and there was significantly statistical difference (P=0.006) between the two groups. Among the unmarried men with bilateral orchidopexy4(66.7%) of the abnormal semen were found in men with intra-abdominal testis.3. Ultrasound founds of testis No cancer was found in all the subjects. Compared with normal testis in unilateral group(15.81±3.64ml), the mean testicular volume of undescended testis (10.78±2.00ml)was significantly decreased (t=7.626, P<0.01). In the bilateral group, the mean testicular volume was9.75±3.75ml. Regarding the testis'position before the operation, the mean volume of intra-abdominal testis in unilateral group was7.49±1.02ml, which was smaller than that of inguinal (10.83±1.95ml) and supra scrota (11.65±1.64ml) testis, and significant differences were found in the three groups, and it was the same in bilateral group. In the unilateral group,4(28.6%) epididymal cysts were found in married subjects, while there was10(52.6%) in unmarried group.5(35.7%) subjects were found with testicular microlithiasis, but all of them had got the paternity, and in unmarried group, testicular microlithiasis were found in8(42.1%) patients. Due to the limited cases of subjects with bilateral orchidopexy, the figures are excluded.4. Sexual function Overall satisfaction of BSFI showed that all married subjects were satisfied with their Sexual function, and the mean BSFI scores of unilateral group was32.93±3.05, which was higher than that in bilateral group (27.88±4.94). Among the unmarried subjects,5(35.7%) were abnormal in sexual function of unilateral group, while it was6(75%) in bilateral group. And there were some sexual problems in subjects of bilateral group, such as problems of sexual drive, erections and ejaculation. And most of them were diagnosed with abnormal semen analysis. For unmarried men,5(26.3%) subjects had sexual drive problems in unilateral group, while5(62.5%) in bilateral group.5. Physical examination In unilateral group, all the subjects were presented with normal male secondary sex characters. But we found some abnormal secondary sex characters in men with bilateral orchidopexy, such as abnormal Adam's apple, reduced pubic hair, smaller testis, smaller penis et al.Conclusions1. Fertility rate in men who underwent unilateral orchidopexy in their childhood was similar to normal men despite the position of testes and age at surgery. Men in bilateral group have rather poorer fertility compared to men who underwent a unilateral procedure. The fertility potential was poor, especially in men with intra-abdominal testes. Some infertile men can father a child after drug therapy.2. In unilateral group, number of subjects with normal semen analysis were similar to general men, while it was decreased in bilateral group. Most semens of men with intra-abdominal testis were abnormal.3. Compared with normal testis in unilateral group, the mean testicular volume of undescended testis was significantly decreased. Regarding the testis'position before the operation, the mean volume of intra-abdominal testes was smaller than that of inguinal and supra scrotal in both unilateral and bilateral group, and significant differences were found in both groups.4. All the subjects were satisfied with their sex. But the sexual function of subjects in bilateral group was poorer than that in unilateral group. For married men, the score of BSFI in bilateral group was significantly lower than that in unilateral group. 5. Some of the findings in physical examination revealed abnormal for subjects with bilateral orchidopexy in male secondary sex characters, especially for men with abnormal semen analysis, while no abnormal subjects was found in unilateral group.
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