Dr Margaret answers emailers’ embarrassing problems
in this monthly problem page.

Fertility after undescended testicle

Dear Dr Margaret
My husband and I have been trying for a baby. When he was a child he had an operation to bring his testicle down. Could this have affected his fertility?

Your question is not easy to answer, but the key point is that his fertility (ability to father a child) may relate to how old he was when he had the operation for undescended testis (testicle).

Most of the research has been done on sperm counts. If the sperm count is low, conceiving a baby could be problematic. Studies of men who had an operation for undescended testis more than 25 years ago suggest that the sperm count could be affected.

We now know that the later the operation, the worse the result for fertility, but no one knew that in the 1970s. Therefore, the reason for such a large effect in these research studies is probably that they go back 25 years, when the operation to bring the testis down tended to be done in late childhood.

If the operation was done before he was 4 years old, the sperm count will be much better. In fact, the sperm count is likely to be normal. This is backed up by studies of samples taken from the actual testis at the time of operation, which show no defect if the operation was done before the age of 1 year. Because of this research, surgeons are now doing operations for undescended testis much earlier than previously.

If you want more general information about undescended testis, look at the section on testicle problems.

I should point out that the volume and appearance of your husband’s semen each time he ejaculates does not tell you anything about the number of sperm it contains. This is because most of the volume of the semen comes from other glands, such as the prostate and ‘seminal vesicles’. Only about 5% comes from the testes. The only way for him to find out his sperm count is to have his semen analyzed at a fertility clinic. If his sperm count is low, various special techniques can help fertilization. For example, a sperm can be injected directly into one of your eggs. And to put the problem in perspective, about 15 –20% of all couples have difficulty conceiving a baby, so any problems you have may not be connected to his previous testis problem.

Sources of information

McAleer IM, Packer MG, Kaplan GW et al. Fertility index analysis in cryptorchidism. Journal of Urology 1995;153:1255 –8.

Leung AK, Robson WL. Current status of cryptorchidism. Advances in Pediatrics 2004;51:351 –77.

O’Brien M, Chandran H. Maldescent of the testis. Surgery2004;22:252 –5.