Aims: To investigate the association between male genital anomalies hypospadias and undescended testis (UDT) and adult reproductive disorders; and the impact of timing of UDT surgery (orchidopexy) on outcomes.
Methods: We conducted a population-based cohort study of all liveborn males in Western Australia (1970-1999), followed-up until 2016 via data-linkage to hospitalizations, congenital anomaly, cancer and assisted reproductive technology (ART) registries. Study factors were hypospadias or UDT and study outcomes were testicular cancer (TC), paternity and use of ART for male factor infertility.
Results: The cohort comprised 350,835 males, 2,484 (0.7%) had hypospadias and 7,499 (2.1%) UDT. There were 530 (0.1%) TC cases, 109,544 (31%) men fathered children and 2,680 (0.8%) men had ART treatment. UDT was associated with a 2.4-fold increase in TC (Hazards Ratio (HR) 2.43; 95%CI 1.65-3.58), and hypospadias with a small increase in TC (HR 1.37; 95%CI 0.51-3.67). Both hypospadias and UDT were associated with a 21% reduction in paternity (adjusted HR (aHR): 0.79; 95%CI 0.71-0.89 and aHR 0.79; 95%CI 0.74-0.85, respectively). UDT was associated with a 2-fold increased ART use (Relative Risk, RR 2.26; 95%CI 1.58-3.25). For every 6-months of increasing age at orchidopexy, there was a 6% increase in risk of TC (HR 1.06; 95%CI: 1.03-1.08), 5% increase in ART use (aHR 1.05; 95%CI 1.03-1.08); and 1% reduction in paternity (RR 0.99; 95%CI: 0.98-0.99).
Conclusion: UDT is associated with increased risk of TC, infertility and decreased paternity. We provide new evidence to support international guidelines for orchidopexy before 18 months in boys with UDT.