Early successful orchidopexy does not prevent from developing azoospermia

Abstract

Introduction: The incidence of Ad spermatogonia (stem cells for fertility) was assessed in 20 cryptorchid patients, all of whom had a successful orchidopexy in childhood but developed azoospermia following puberty. Materials and Methods: From a cohort of 231 patients who had a semen analysis following successful orchidopexy 20 patients (9%) had azoospermia. The patients were classified into 2 groups according to the time of surgery: A = < 21 months of age (n = 5, mean = 10.7 ± 8.6 months) and B = during childhood (n = 15, mean = 10.1 ± 3 years). Nine of the 20 patients (45%) had bilateral cryptorchidism: A = 1 and B = 8. Testicular biopsies were performed during orchidopexy and analyzed with semi-thin technique. The number of Ad spermatogonia and entire number of germ cells was determined. The patients' semen analyses were evaluated at least twice; FSH and testosterone plasma values were estimated. Results: In group A, all patients had germ cells at the time of surgery (mean = 1.04 ± 1.4 germ cells per tubular cross section); only 6 patients in group B (40%) had no germ cells (mean = 0.17 ± 0.4); A vs. B, p = 0.0133. Importantly, Ad spermatogonia were absent in the entire study population. The plasma FSH of 16 patients (80%) was abnormal [median = 16.35 IU/L (Interquartile range of sample - IQR 9.075-27.85 95% CI, 3-53)] while the plasma testosterone of all the patients was normal. Conclusions: The most severe cause of infertility in cryptorchid patients cannot be mitigated by an early successful surgery alone.