Phillips Lottie, Lundholm Cecilia, Örtqvist Lisa, Almqvist Catarina, Nordenskjöld Agneta, Skarin Nordenvall Anna
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Deparment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Andrology. 2021 May;9(3):810-816. doi: 10.1111/andr.12975. Epub 2021 Feb 10.
It is not known if impaired fertility in men with hypospadias is caused by decreased semen quality or other factors. Semen quality in men born with hypospadias may be impaired due to effects of androgens or testicular dysgenesis but has been very little studied.
To study semen quality in men with hypospadias using dizygotic twinning rates as an epidemiological indicator. We further aimed to study men treated for cryptorchidism, given a hypothesized mutual etiology for decreased semen quality.
We conducted a population-based study using national Swedish registers. A total of 4,363,165 births between 1964 and 2013 were included. The association between hypospadias and cryptorchidism, and fathering dizygotic multiple births was estimated using logistic regression and presented as odds ratios. The main analyses excluded births conceived using assisted reproductive technology (ART).
We identified a total of 5317 births with fathers with hypospadias, including 26 dizygotic births conceived unassisted. No significant association was found between hypospadias and dizygotic twinning (OR 1.10, 0.75-1.61). We estimated a significantly increased odds for dizygotic multiple births in men treated for cryptorchidism (OR 1.35, 1.01-1.81) which was decreased after exclusion of ART, but the estimate was not significant (OR 0.75, 0.48-1.18).
Using dizygotic twinning rates as an indicator of semen quality, we did not find any difference between fathers with hypospadias and controls. Due to sample size, we could not analyze phenotypes separately and can therefore not exclude impaired semen quality in severe hypospadias. We could not demonstrate any association between dizygotic twinning and cryptorchidism. Men treated for cryptorchidism were more likely than controls to use ART to conceive.
Men with hypospadias who conceived without ART were not shown to have impaired semen quality using dizygotic twinning as an epidemiological indicator.
尿道下裂男性生育能力受损是否由精液质量下降或其他因素引起尚不清楚。由于雄激素的影响或睾丸发育不全，出生时患有尿道下裂的男性精液质量可能会受损，但这方面的研究非常少。
以双卵双胎率作为流行病学指标，研究尿道下裂男性的精液质量。鉴于精液质量下降存在共同病因的假设，我们还旨在研究接受隐睾症治疗的男性。
我们利用瑞典国家登记册进行了一项基于人群的研究。纳入了1964年至2013年间的4363165例出生记录。使用逻辑回归估计尿道下裂和隐睾症与生育双卵多胞胎之间的关联，并以比值比表示。主要分析排除了使用辅助生殖技术（ART）受孕的出生记录。
我们共确定了5317例父亲患有尿道下裂的出生记录，其中包括26例自然受孕的双卵双胎出生记录。未发现尿道下裂与双卵双胎之间存在显著关联（比值比1.10，0.75 - 1.61）。我们估计接受隐睾症治疗的男性生育双卵多胞胎的几率显著增加（比值比1.35，1.01 - 1.81），排除ART后该估计值有所下降，但不显著（比值比0.75，0.48 - 1.18）。
以双卵双胎率作为精液质量的指标，我们未发现尿道下裂父亲与对照组之间存在任何差异。由于样本量的原因，我们无法分别分析表型，因此不能排除严重尿道下裂患者精液质量受损的情况。我们未证明双卵双胎与隐睾症之间存在任何关联。接受隐睾症治疗的男性比对照组更有可能使用ART受孕。
以双卵双胎作为流行病学指标，未接受ART受孕的尿道下裂男性未显示出精液质量受损。
