Fertility Potential After Unilateral Orchiopexy: Simultaneous Testicular Biopsy and Orchiopexy in a Cohort of 87 Patients

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Abstract
Purpose: We investigated the prognostic value of the number of spermatogonia per tubular cross section in a testicular biopsy specimen obtained at orchiopexy for unilateral cryptorchidism. Materials and Methods: A total of 87 consecutive 10 to 12-year-old cryptorchid boys underwent testicular biopsy simultaneously with unilateral orchiopexy. In adulthood 56 of the 87 patients agreed to measurement of serum follicle-stimulating hormone, luteinizing hormone, testosterone and testicular volume, and 54 provided specimens for semen analysis. Results: The number of spermatogonia per tubular cross section correlated to the volume of the operated testis and total testicular volume in adulthood. Serum follicle-stimulating hormone negatively correlated to these volumes, sperm concentration and total sperm count. Contralateral testicular volume correlated to sperm concentration, total sperm count, and percent of living and mobile sperm. When biopsy revealed Sertoli cells only or 1 spermatogonium per 100 tubular cross sections, the age matched number of spermatogonia per tubular cross section was 1 percent or less. Of these patients 33 percent later presented with 5 million spermatozoa per ml. or less, no normal motility and generally lower sperm concentrations than those with more than 1 spermatogonium per 100 tubular cross sections (greater than 1 percent) in the biopsy specimen. When the value was greater than 1 percent, later sperm quality was not significantly reduced in comparison to that of the general population. Conclusions: The age matched number of spermatogonia per tubular cross section is significant in regard to fertility potential, and a value of 1 percent or less (approximately Sertoli cells only) may predict low fertility potential. To our knowledge Sertoli cells only have not been observed before 15 months of life, which makes it logical to treat cryptorchidism before this age even in unilateral cases.