The human body is made up of several parts that we often compare to machine gears, which need to be “whole” and receive proper maintenance to work in harmony. The same goes for the human reproductive system, which forms during the last months of gestation. In males, the testicles of a developing baby boy form inside the abdomen and then begin their descent through the inguinal canal, finally reaching the scrotal sac where they will remain for life. When any issue occurs during this journey, causing one or both testicles not to reach the scrotal sac, this is called cryptorchidism.

What Is Cryptorchidism?

Cryptorchidism, or undescended testicles as it is commonly known in medicine, is the term for a very common genital alteration in males. It refers to the absence of testicles in the scrotal sac or the presence of only one testicle. It is classified as unilateral when only one testicle is present and bilateral when both are absent, and it is divided into two types:

  • Congenital Cryptorchidism
  • Acquired Cryptorchidism

Congenital Cryptorchidism

Congenital cryptorchidism is defined as the absence of one or both testicles in a baby, right after birth. Since the male reproductive system finishes developing in the last months of intrauterine development, in these cases one or both testicles do not reach the scrotal sac as they should.

Acquired Cryptorchidism

Acquired cryptorchidism is when a baby is born with his testicles properly located in the scrotal sac, but after a certain period, one or both testicles are no longer observed in the scrotal area.

Causes of Cryptorchidism

The causes of cryptorchidism are still not fully understood, but scientific studies on the subject point to strong possibilities of being the result of genetic factors during pregnancy or even environmental influences. However, among the main and most consistent causes are prematurity at birth or babies being born below the weight for gestational age.

Diagnosis of Cryptorchidism

The diagnosis of cryptorchidism is basically clinical and can be identified after a simple but thorough physical examination. It is necessary to observe and evaluate the position, testicular volume, and also the mobility of the testicles, which may indicate other factors such as hernias, penile size, hydrocele (accumulation of fluid in the testicular area), as well as the position of the urethral meatus, which is the urinary opening on the penis.

Usually, cryptorchid testicles can be easily palpated, which makes localization easier; in 80% of cases, they are found between the abdomen and the scrotal sac, making treatment simpler. In cases where they cannot be easily felt, the testicles may still be inside the abdominal cavity, indicating a more complex procedure and specific treatment.

Treatments for Cryptorchidism

The treatment for cryptorchidism will depend on the medical evaluation and the choice of the best approach for the case. However, in the case of congenital cryptorchidism, where babies are already born without one or both testicles in the scrotum, it is usually recommended that parents wait until the baby is six months old to observe if the testicle descends naturally into the scrotal sac, without the need for any intervention or treatment.

After this period, if spontaneous descent does not occur, the best corrective intervention is considered. The recommendation is that surgical intervention takes place between six and twelve months of age, with the maximum correction deadline being up to eighteen months of life. The main goals of surgical correction of testicular position are to optimize testicular function, prevent future complications such as hernias and testicular torsion, and reduce the risk and make it easier to diagnose testicular tumors.

For testicles that can be palpated even outside the scrotal sac, surgical correction is indicated to bring the testicle into the scrotum. The position of the testicle will be assessed, and the type of procedure determined, which can be via the inguinal or scrotal approach. For non-palpable testicles, the recommended surgery is abdominal and performed by laparoscopy, which is simpler, faster, and has a smooth recovery.

Fertility

One of the major concerns regarding cryptorchidism is fertility. Research shows that patients with only one testicle that has not descended into the scrotum have lower fertility rates but can still become fathers, at a rate similar to those with both testicles in the correct position.

However, surgical correction is necessary to ensure proper sperm production, both in quality and quantity during ejaculation. If the testicles are not corrected, the undescended testicle may compromise sperm production and the production of the hormone testosterone, resulting in infertility.

For patients with bilateral cryptorchidism (absence of both testicles in the scrotal sac), fertility rates are minimal. Therefore, surgical treatment within the correct timeframe—during the first year of life—is essential to prevent infertility from becoming irreversible.

Taking this opportunity, we want to share some news for our readers who need a little extra support for fertility. For patients with unilateral cryptorchidism who need to boost semen production, Famivita has developed a line of products aimed at couples’ fertility, including the vitamin ViriFerti, a complete vitamin supplement that improves and enhances male fertility, resulting in better semen quality and healthier sperm. You can purchase it here in our online store.

Another medical concern related to cryptorchidism, which has been evaluated in several studies, is the increased risk of testicular tumors in affected patients. Research indicates that the risk is 2 to 5 times higher compared to men who were not born with cryptorchidism. This is possibly because these patients are already born with a genetic predisposition to this type of cancer. Even after the recommended treatment and surgical intervention, it is necessary to recommend self-examination of the testicles to detect any changes early.

Photo: Tsaitgaist