Does Testicular Torsion Cause Infertility?

Testicular torsion is a medical emergency where a testicle twists, cutting off its blood supply. If not addressed promptly, this condition can lead to severe complications, including potential long-term effects on male fertility. Understanding testicular torsion and its treatment is important for preserving reproductive health.

Understanding Testicular Torsion

Testicular torsion involves the twisting of the spermatic cord, which contains blood vessels, nerves, and the tube that carries sperm from the testicle. This action restricts or cuts off blood flow to the affected testicle. The condition is most common in males between 12 and 18 years old, but it can occur at any age, even before birth.

Symptoms typically appear suddenly and include severe pain in the scrotum, which may extend to the abdomen. Swelling, nausea, and vomiting are common accompanying signs. The affected testicle might appear higher than normal or at an unusual angle. Any sudden, intense scrotal pain warrants immediate medical attention.

The Role of Timely Treatment

The primary treatment for testicular torsion is emergency surgery, known as detorsion and orchiopexy. During this procedure, a surgeon untwists the spermatic cord to restore blood flow. The testicle is then stitched to the inside of the scrotum to prevent future twisting.

Timely intervention is necessary to prevent irreversible damage to the testicle. The window for saving the testicle is narrow, with best outcomes achieved when surgery occurs within four to six hours of symptom onset. If treatment is delayed, the risk of permanent damage or testicle loss significantly increases. The salvage rate can drop to about 50% after 12 hours and to roughly 10% after 24 hours.

How Testicular Torsion Can Affect Fertility

Testicular torsion can impact fertility through several direct mechanisms. Prolonged interruption of blood supply leads to ischemia, a condition where tissues are deprived of oxygen and nutrients. This can damage sperm-producing germ cells and supporting cells within the testicle. The extent of this damage often correlates with the duration and degree of twisting.

Damage is not limited to the affected testicle; an autoimmune response can also impact the unaffected testicle. The disruption of the blood-testis barrier in the injured testicle can expose sperm antigens to the immune system. This can lead to anti-sperm antibodies attacking sperm from the healthy testicle, impairing fertility. Additionally, testicular torsion can lead to lower testosterone levels, which can negatively influence sperm production.

Long-Term Fertility Outlook

The long-term fertility outlook after testicular torsion is influenced by several factors, including the duration of the torsion, the degree of twisting, and the patient’s age. Prompt treatment significantly improves the chances of preserving testicular function and fertility. Many individuals retain fertility, especially if the affected testicle is salvaged quickly.

Despite successful treatment, some individuals may still experience reduced sperm count or motility. Studies indicate that some patients may have lower sperm quality, with some classified as subfertile years after the event. If fertility concerns arise, assessment options include semen analysis to evaluate sperm count, motility, and morphology. Should fertility issues persist, assisted reproductive technologies may be considered.

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