Cryptorchidism is a medical condition where one or both testes do not descend into the scrotum before a baby is born or in the early months of life. This condition is relatively common, affecting about 3% of full-term male infants and up to 30% of those born prematurely. The testicles form in the abdomen during fetal development and typically move into their proper position in the scrotum in the last couple of months of pregnancy.
Understanding Causes and Risk Factors of Cryptorchidism
During fetal development, testicles form within the abdomen and normally travel down into the scrotum around the 28th week of gestation. This descent is a complex process guided by hormonal signals, such as androgens, and physical factors like the regression of a ligament-like structure called the gubernaculum. The exact reason why this process sometimes fails is not always clear, but experts believe a combination of genetics, maternal health, and environmental factors can disrupt the normal development.
Premature birth and low birth weight are the most significant risk factors. A family history of cryptorchidism or other genital development issues also elevates the risk. Certain maternal health conditions and behaviors during pregnancy, such as diabetes, smoking, alcohol consumption, or exposure to pesticides, may also contribute to the condition by interfering with the hormonal or physical mechanisms of testicular descent.
Identifying Cryptorchidism and Medical Consultation
Cryptorchidism is most often identified during a physical examination of a newborn, as the primary sign is not being able to feel one or both testicles within the scrotal sac. In most cases, the undescended testicle is located in the inguinal canal, the passage through which it travels from the abdomen. If a parent is unable to locate a testicle in their baby’s scrotum, seeking a medical evaluation is advised to ensure an accurate diagnosis.
It is important to distinguish a true undescended testicle from a retractile one. A retractile testicle is one that has descended but can temporarily pull back up into the groin, often due to a muscle reflex. These testicles do not typically require treatment but should be monitored.
Consequences of Untreated Cryptorchidism
The scrotum maintains a cooler temperature than the rest of the body, which is necessary for normal sperm production. When a testicle remains in the abdomen or groin, the higher body temperature can impair sperm development, potentially leading to reduced fertility or infertility. The infertility rate can be as high as 90% if bilateral cryptorchidism is left untreated.
There is also an increased risk of developing testicular cancer in the undescended testicle, and to a lesser extent, in the properly descended one. An undescended testicle is also more susceptible to testicular torsion, a painful twisting of the spermatic cord that cuts off blood supply and requires emergency surgery. Additionally, an inguinal hernia, where part of the intestine bulges through a weak spot in the abdominal muscles, often accompanies an undescended testicle.
Available Treatment Options for Cryptorchidism
In many cases, an undescended testicle will move into the scrotum on its own within the first few months after birth, so a period of “watchful waiting” is often the initial approach. If the testicle has not descended by about six months of age, medical intervention is recommended, as spontaneous descent is unlikely after this point.
The standard and most effective treatment is a surgical procedure called orchiopexy. Usually performed between 6 and 18 months of age, this surgery involves a surgeon carefully repositioning the testicle into the scrotum and securing it in place. Orchiopexy has a very high success rate, around 98%, and is done to reduce long-term health risks. Hormonal therapy using injections like hCG is a much less common option with lower success rates and is generally not the primary treatment.
Life After Cryptorchidism Treatment
The outlook for individuals who receive timely treatment for cryptorchidism is positive. Following a successful orchiopexy, the testicles usually develop normally within the scrotum. Fertility rates are often near-normal, particularly when only one testicle was undescended and corrected early. The prognosis for fertility may be more guarded in cases where both testicles were undescended or if treatment was significantly delayed.
A long-term consideration is the continued, slightly elevated risk of testicular cancer. Because of this, individuals treated for cryptorchidism should learn how to perform testicular self-examinations starting in their teenage years. Regular check-ups with a healthcare provider and ongoing awareness are part of post-treatment care.