Leydig cell function after cryptorchidism: Evidence of the beneficial result of early surgery

Purpose: We determined whether there are differences indicative of the function of the Leydig cell-pituitary axis in formerly unilateral cryptorchid men. Parameters were compared with those in control men. Materials and Methods: We determined luteinizing hormone, testosterone, free testosterone, follicle-stimulating hormone, inhibin B, sperm density, motility and morphology, testicular volume, patient weight and age at orchiopexy or at other nonrelated childhood surgery in controls. Results: Significant correlations were noted between hormone levels and other parameters. An inverse correlation between age of surgery and testosterone suggested the detrimental effect of deferring orchiopexy during childhood. Correlations of testosterone with sperm density, motility and morphology suggested a direct relationship between spermatogenesis and testosterone in cryptorchid men. An inverse relationship between body weight and testosterone was observed in each group. There was considerable variation in the range of parameters, sometimes extending into the abnormal range. However, results indicated no differences in mean free testosterone, testosterone or luteinizing hormone in the formerly cryptorchid and control groups, and no difference in time to conception in fertile, formerly cryptorchid men and controls. Furthermore, there were no differences in hormone levels in fertile (as indicated by paternity) and infertile formerly cryptorchid men. Conclusions: This study suggests that men who underwent orchiopexy in later childhood have subclinically decreased Leydig cell function. It may result in a less than optimal hormonal milieu for adult reproductive function. These data provide support for orchiopexy during infancy to preserve Leydig cell function and, thereby, potentially enhance fertility.