EPIDEMIOLOGY OF MALE INFERTILITY: CRYPTORCHIDISM

隐睾症是男性不育的主要原因，但研究很少。 来自于对在儿童医院接受治疗的一个大型男性队列的研究， 在匹兹堡，我们已经确定， 以前双侧和单侧隐睾男性相比， 对照 我们现在建议使用该队列进一步评估风险 隐睾后不孕的因素和指标（特别是 精子和激素指标）来确定这种情况的影响， 治疗和年龄。 不育伴 隐睾症可能是由于进行性的，不可逆的损害， 未降睾丸的细胞在治疗前的儿童时期，从 手术矫正的效果，或这些的各种组合。 因为并非所有的研究对象都试图确定父亲身份，我们建议 与以下相关的可以量化的研究参数 可能适用于整个队列的亲子鉴定。 我们 将检验以下假设：（1）精子质量和数量减少 隐睾后精子密度，总计数， 血清促卵泡激素（FSH） 隐睾症患者的水平升高，反映了 睾丸精子生成元素;（3）血浆睾酮，总睾酮和 在以前的隐睾男性中，由于睾丸 损伤;（4）自变量矫正年龄 隐睾，手术类型，预处理部位和大小 隐睾与精子参数较差有关， FSH升高睾酮和游离睾酮降低 本研究 将确定男性不育的预测因素（潜在的预测因素-精子 参数，FSH，睾酮，游离睾酮），并评估获益 隐睾症的治疗和年龄。 我们提供数据给 验证我们建议测量的参数可以确定， 解决我们的假设 我们将使用激素检测， 经验，并能充分发现个体之间的差异。 精子分析将与生殖健康部合作进行。 网络包括精子活力的录像，用于计算机分析。的 结果将提供隐睾后生育能力的定义， 不仅为隐睾症的治疗提供了指导方针的基础， 但对于治疗和咨询前隐睾男子有关 生育

Cryptorchidism is a major, but poorly studied, cause of male infertility. From studies of a large cohort of men treated at the Children's Hospital of Pittsburgh, we have determined that attempted paternity is decreased in both formerly bilateral and unilateral cryptorchid men compared with controls. We now propose to use this cohort to further assess risk factors and indicators of infertility after cryptorchidism (specifically sperm and hormone indicators) to determine the effect of this condition, its treatment and age of treatment. Infertility associated with cryptorchidism may result from progressive, irreversible damage to germ cells of the undescended testis during childhood prior to treatment, from effects of operative correction, or from various combinations of these. Because not all study subjects have attempted paternity, we propose to study parameters that can be quantified which are associated with paternity that will be potentially available for the entire cohort. We will test hypotheses that (1) sperm quality and quantity are diminished after cryptorchidism as reflected by decreased sperm density, total count, motility and morphology; (2) serum follicle-stimulating hormone (FSH) levels are elevated in cryptorchid men, a reflection of damage to testicular sperm producing elements; (3) plasma testosterone, total and free, is diminished in formerly cryptorchid men because of testicular injury; and (4) the independent variables of age of correction of cryptorchidism, type of surgery, location and size of the pretreatment undescended testes are associated with poorer sperm parameters, more elevated FSH and lower testosterone and free testosterone. This study will identify predictors of male infertility (potential predictors-sperm parameters, FSH, testosterone, free testosterone) and assess the benefit of treatment and age of treatment of cryptorchidism. We present data to verify that the parameters we propose to measure can be determined to address our hypotheses. We will use hormone assays with which we have experience and can sufficiently detect differences between individuals. Sperm analyses will be done in collaboration with the Reproductive Health Network including videotaping of sperm motility for computer analysis. The results will provide a definition of fertility after cryptorchidism, provide a basis for guidelines not only for treatment of cryptorchidism, but for treatment and counseling of formerly cryptorchid men concerning fertility.