The Study Of Fertility Capacity After Surgical Treatment For Cryptorchidism

Background: Cryptorchidism is one of the most frequent developmental abnormalities afflicting human boys .Cryptorchidism is the condition in which one testis (unilateral) or both testes(bilateral) fail to fully descend into ideal scrotal position . In newborns,the reported prevalence of cryptorchidism is ranged from 0.8% to 3%. The detained in inguinal canal or Intraabdominal testis because of short of normal microenvironment will result in infertility. Spermatogenic cell will appear holding up maturity. Cryptorchidism may be a major factor in male infertility. There is 5%-10% male sterility patients who have cryptorchid .Almost all men with untreated bilateral cryptorchidism are infertile .Incidence of cryptorchidism have an increase tendence for the past thirty years.With rapid progress of urbanization and industrialized in our country,infertility ratio is also rapidly increase. Investigation of WHO , 15% of married couples are infertility in which masculine sterility reasons is up to 40-50% .The propotion of male factor is gradually ascended .With the development of industry, human survivable environment is incurring severe polluted. Some studies show that the incidence of cryptorchidism in England is add up to twice times like others developed nations in Europe and America. Now the therapy of cryptorchidism includes some methods such as observation,hormone,operation. There are some disputes in which the main dispute is that how to chose the time of operation.In the old time the patients were advised to take hormone therapy before 2 years old .Some professor think that the hormone therapy cause the elevating T,LH,FSH levels and result in impaired spermatogenesis. Several studies have detaile the hormonal and histologiocal features of cryptochid testes and the outcomes of clinical therapy ,the result are controversial.The efficacy of early therapy has been questioned , especially for unilateral cryptorchidism. We retrospectively study the clinical epidemiology of cryptorchidism after operation to understand the associativity of the time of operation and the fertility capacity and guide the choice of the time of operation .Objective: To analysis the infertility, sperm during adulthood in cryptorchid patients operated on during childhood, and to assess these variables according to the age at surgery.Methods : A letter was sent to all 1024 patients who underwent surgery for cryptorchidism less than 16 years old;412 responded and were assessed using a sexual history, physical examination, sperm analysis, paternity.And 50 normal control were studied. 22 cases was ruled out because these patients have been recognized additional infertility factors. Clinical, surgical records at surgery were reviewed. 390 cases were studied.If the patients had been paternity, their samples of semen needn't to be provided.Or their samples of semen for analysis were provided and evaluated according to the WHO standards. If their sperm count was too low, they will be informed to send twice again at appropriate time.Results:There are 298 unilateral cryptochidism cases,including 164 left cases, 134 right cases ;107 bilateral cases.There are 4 patients were infertility in control patients.Operated before 2 years old ,there are 5 infertility cases in 48 unilateral case,and 4cases in 19 bilateral cases.13 of the 98 unilateral cryptorchidism patients experience infertility ,while 9of 35 bilateral cryptorchidism patients who operated on 2 to 5years .When orchiopexy was done at ages 5 to 12 years ,14 unilateral cases were infertility and 79 unilateral cases were paternity;11 bilateral cases were infertility and 24 bilateral cases were paternity.Percentage of men reporting succeess after attempting paternity is 81.63%(48 of 59) in unilateral cases and 36.84%(7 of 19) in bilateral cases who were operated younger than 16 years old .The infertility unilateral patients gave their three perm samples.We analyzed the sperm density, sperm motility, sperm malformation .Conclusions:This study indicated early diagnosis and orchiopexy are needed to preserve fertility. The obstetrician and pediatricican should chang the stale view.