Henriksen Anna Lund, Poulsen Ida-Marie, Sørensen Freja, Fedder Jens
Centre of Andrology & Fertility Clinic, Department D, Odense University Hospital, DK-5000 Odense, Denmark.
Department of Clinical Medicine, University of Southern Denmark, DK-5000 Odense, Denmark.
J Clin Med. 2025 Jul 5;14(13):4768. doi: 10.3390/jcm14134768.
Male infertility can arise from various causes, accounting for 30-50% of infertility cases. The aim of this systematic review is to establish paternity outcomes in men treated for cryptorchidism during childhood, and to evaluate the optimal age for surgical intervention in relation to fertility. This systematic review is conducted according to the PRISMA guidelines and registered in PROSPERO (CRD420251010710). The electronic databases Medline, Embase, and PubMed were searched for eligible studies from 1990 to February 2025. All types of original published human studies examining paternity outcomes in men treated for cryptorchidism during childhood were included. This review focused on comparing paternity rates between men treated for unilateral versus bilateral cryptorchidism. Additionally, studies were required to assess the influence of age at the time of treatment on the likelihood of achieving paternity later in life. Risk of bias was assessed using the Newcastle-Ottawa Scale. Six studies were included. Five out of six studies found higher paternity rates in men treated for unilateral cryptorchidism compared to bilateral cryptorchidism. Early intervention is preferable, although delayed treatment in early childhood may still preserve fertility. One large study showed a 5% increase in the need for assisted reproductive treatment (ART) for every six-month delay in surgery, with a significantly higher use of ART observed when surgery was performed after 18 months. Bilateral cryptorchidism and delayed orchiopexy are linked to lower fertility and the increased use of ART. Future studies should focus on high-quality research to define the optimal age for orchiopexy in relation to paternity.
男性不育可由多种原因引起，占不育病例的30%-50%。本系统评价的目的是确定童年期接受隐睾症治疗的男性的生育结果，并评估与生育相关的手术干预的最佳年龄。本系统评价按照PRISMA指南进行，并在PROSPERO（CRD420251010710）注册。检索了电子数据库Medline、Embase和PubMed中1990年至2025年2月的 eligible研究。纳入了所有类型的已发表的关于童年期接受隐睾症治疗的男性生育结果的原始人类研究。本评价重点比较单侧与双侧隐睾症治疗男性的生育成功率。此外，研究还需评估治疗时的年龄对日后生育可能性的影响。使用纽卡斯尔-渥太华量表评估偏倚风险。纳入了六项研究。六项研究中的五项发现，与双侧隐睾症治疗的男性相比，单侧隐睾症治疗的男性生育成功率更高。早期干预更可取，尽管幼儿期延迟治疗仍可能保留生育能力。一项大型研究表明，手术每延迟六个月，辅助生殖治疗（ART）的需求就会增加5%，当手术在18个月后进行时，ART的使用显著增加。双侧隐睾症以及延迟睾丸固定术与较低的生育能力和ART使用增加有关。未来的研究应侧重于高质量研究，以确定与生育相关的睾丸固定术的最佳年龄。
