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CRYPTORCHIDISM AND MALE FERTILITY: A STUDY OF THE DETERMINANTS OF INFERTILITY AMONG FORMERLY CRYPTORCHID AND CONTROL MEN

Coughlin, Michael T. (2005) CRYPTORCHIDISM AND MALE FERTILITY: A STUDY OF THE DETERMINANTS OF INFERTILITY AMONG FORMERLY CRYPTORCHID AND CONTROL MEN. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Background: Cryptorchidism is a failure of the testis to descend into the scrotum from its initial site of development in the abdomen. The failure of the testis to descend results in significant histologic changes to the testicular tissues and increases risk for infertility and testicular cancer. Incidence of cryptorchidism is approximately 3% at birth declining to 1% at one year of age because of spontaneous descent. Little to no spontaneous descent occurs after six months of age and surgical correction by orchiopexy is recommended by age one to two.Study Cohort: The Children's Hospital of Pittsburgh Male Fertility Study has been looking at the impact of cryptorchidism on male fertility since 1992. The study cohort comprises 1405 former cryptorchids and control men. Each of the subjects completed an extensive questionnaire that included questions on marriage and cohabitation, paternity, health problems, and environmental/occupational exposures. A subset of the full cohort returned in adulthood for evaluation of hormone levels and semen analysis (n=167).Results: The articles presented here represent a selection of the study results looking at time to conception among formerly cryptorchid men, the impact of testicular suture on fertility, and the influence of age at orchiopexy on hormone levels and sperm count. Time to conception is significantly increased among formerly bilateral (33.9 months), but not unilateral cryptorchid men (11.1 months) as compared to control men (8.8 months). Placement of a transparenchymal suture during orchiopexy greatly increases the risk of infertility (RR 7.56) among formerly cryptorchid men. Age at orchiopexy is significantly negatively correlated (r= -0.274) with inhibin B and positively correlated (r=0.229) with FSH.Conclusions: Cryptorchidism negatively impacts fertility in the human male. It can increase time to conception and reduce sperm counts, especially among formerly bilateral cryptorchid men. Surgical technique utilizing placement of a suture through the testis can greatly increase risk for future infertility and should be avoided. With an incidence of 3% at birth and a prevalence of 1% at one year, it represents the single most common birth defect among human males. Cryptorchidism is of public health importance because it leads to significantly increased risks for both testicular cancer and infertility. Future research should focus on identifying environmental and behavioral causes of cryptorchidism and on optimizing treatment.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Coughlin, Michael T.mtcst9@imap.pitt.edu
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairNess, Roberta Bnessr@edc.pitt.edu
Committee MemberLee, Peter Aplee@psu.edu
Committee MemberLaPorte, Ronald Eronlaporte@aol.com
Committee MemberBelle, Steven Hbelle@edc.pitt.eduSBELLE
Date: 4 January 2005
Date Type: Completion
Defense Date: 25 October 2004
Approval Date: 4 January 2005
Submission Date: 9 December 2004
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Epidemiology; Infertility; Orchiopexy; Undescended Testis; Cryptorchidism; Male
Other ID: http://etd.library.pitt.edu/ETD/available/etd-12092004-235945/, etd-12092004-235945
Date Deposited: 10 Nov 2011 20:09
Last Modified: 15 Nov 2016 13:54
URI: http://d-scholarship.pitt.edu/id/eprint/10242

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