Impact on fertility

Of men with untreated unilateral cryptorchidism (and still cryptorchid on semen analysis), 50-70% are

azoospermic or oligozoospermic [1]. In contrast, almost all men with untreated bilateral cryptorchidism are infertile [1]. Although the mechanisms for impaired fertility in these cases are not completely understood, the following alterations have been discussed aetiologically [1-3]:

? Decreased number of tubules containing spermatogonia

? Decreased number of spermatogonia per tubulus

? Mild concomitant hypogonadotrophic hypogonadal situation

? Damaging effects on the contralateral testis

? Induction of sperm antibodies

? Epididymal malformations

Although no real consensus exists, it seems logical to suggest orchiectomy as treatment of choice for the majority of infertile men presenting with unilateral cryptorchidism. This is in accordance with accepted thinking that the malignant potential of abnormally located testis increases with age [4].

In the era of ICSI, TESE may be considered during operation for sperm retrieval in azoospermic men. In patients with bilateral cryptorchidism, it is very difficult to decide between conservative orchiectomy (plus testosterone substitution) and orchidopexy (after biopsy excluded carcinoma in situ). There is no consensus, neither in the literature nor in the infertility group.

References

Leissner J, Filipas D, Wolf HK, Fisch M.

The undescended testis: considerations and impact on fertility. Br J Urol 1999; 83: 885-892.

Rozanski ??, Bloom DA.

The undescended testis. Theory and management. Urol Clin North Am 1995; 22: 107-118.

Cortes D.

Cryptorchidism - aspects of pathogenesis, histology and treatment. Scand J Urol Nephrol 1998; 32 (Suppl): 196.

Rogers E, Teahan S, Gallagher H, Butler MR, Grainger R, McDermott ??, Thornhill JA.

The role of orchiectomy in the management of postpubertal cryptorchidism. J Urol 1998; 159: 851-854.

7. IDIOPATHIC OLIGOASTHENOTERATOZOOSPERMIA³

Introduction

Idiopathic oligoasthenoteratozoospermia (OAT) is one issue of empiric drug therapy in unexplained infertility. The effectiveness in terms of evidence-based medicine is low.

Diagnosis

Diagnosis is made according to WHO criteria (see above Andrological investigations and spermatology). However, even if semen analysis shows azoospermia or extreme oligospermia, it seems obvious that circumstances such as duration of the couple's infertility, previous pregnancy history and the female partner's age are more predictive than sperm quality findings.

Idiopathic male infertility

The majority of men presenting with infertility have OAT of unknown cause [1,2].

7.3 Treatment

The effect of any infertility treatment has to be considered with respect to the likelihood of spontaneous conception. Prediction scores for live births in untreated infertile couples have been 62% [3] and 76% [4]. Criteria for the analysis of all therapeutic trials have been re-evaluated [1,5-8], including study design, statistical analysis and goal of therapy.

There is consensus that only randomized controlled trials with the outcome parameter "pregnancy" can be accepted for efficacy analysis.

The following empiric therapies are under discussion (Table 12):

Date: 2016-06-12; view: 253