Undescended Testicle and Fertility: Why Early Treatment Matters
Manar Hegazy
Majd Eddin Khaled
An undescended testicle, or cryptorchidism, occurs when one or both testicles are not located in the scrotum. The testicle may be in the groin, high scrotal area, or abdomen. This is not only an anatomical issue; it can affect future testicular development, sperm production, and fertility potential. Early diagnosis and timely treatment are therefore important for protecting male reproductive health as much as possible.
What is an undescended testicle?
An undescended testicle is a testicle that has not moved fully into the scrotum. Some testicles descend naturally in the first months of life, but if the testicle remains undescended after 6 months, spontaneous descent becomes less likely and specialist evaluation is recommended. It is also important to distinguish a true undescended testicle from a retractile testicle, because management is different.
Why the testicle needs to be in the scrotum
The scrotum keeps the testicle cooler than core body temperature. This cooler environment is important for testicular development and future sperm production. When the testicle remains higher in the body, prolonged heat exposure may affect the cells involved in sperm formation. This is one reason why long-term waiting is not recommended.
Does cryptorchidism affect fertility in every boy?
Not equally. Many men with a single undescended testicle treated early can still have children later in life. The risk is generally higher when both testicles are affected or when treatment is delayed. This is why families need balanced counseling: early treatment reduces risk, but no treatment can promise perfect fertility in every case.
How Cryptorchidism May Affect Future Sperm Production
The fertility impact of an undescended testicle is related to testicular environment and germ-cell development. The child may look completely healthy, but the effect can appear years later in semen analysis or difficulty conceiving.
Heat exposure and testicular tissue development
A testicle located in the groin or abdomen is exposed to higher temperature than a testicle in the scrotum. Over time, this may affect the cells that later support sperm production. Early orchiopexy aims to reduce this exposure and preserve fertility potential as much as possible.
One-sided versus two-sided undescended testicles
In unilateral cases, the other testicle may compensate for much of future fertility, especially when treatment is early. In bilateral cases, fertility risk is higher because both testes may be affected. Bilateral cryptorchidism therefore needs particularly careful evaluation and long-term awareness.
Undescended testicle and azoospermia in adulthood
Men with a history of untreated or late-treated cryptorchidism, especially bilateral cases, may later present with severe sperm abnormalities or azoospermia. In selected men, sperm retrieval with ICSI may be discussed, and reviews suggest that previous cryptorchidism treated by orchiopexy may still allow sperm retrieval in some azoospermic men. However, success is not guaranteed.
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Early Diagnosis of Undescended Testicle and When to See a Doctor
Diagnosis usually begins with physical examination. The doctor checks whether the testicle is palpable, whether it can be brought into the scrotum, whether it stays there, and whether one or both sides are affected. Early diagnosis matters because delaying evaluation may miss the best timing for surgery.
Testicular examination after birth and during follow-up visits
The scrotum should be checked after birth and during routine child visits. If a testicle is absent from the scrotum, it is usually followed during the first months. If it has not descended by 6 months, referral to a specialist is recommended. This prevents unnecessary waiting.
Is ultrasound always needed before treatment?
Not usually. In many cases, imaging is not recommended before referral because physical examination is the key step and imaging often does not change management. If the testicle is not palpable, the specialist may decide whether surgical or laparoscopic evaluation is needed.
Retractile testicle versus true undescended testicle
A retractile testicle may move up and down because of a muscle reflex and may not need surgery if it remains able to sit normally in the scrotum. However, it should be monitored because some retractile testes may ascend later. A true undescended testicle does not remain properly in the scrotum and usually needs timely surgical correction.
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Early Treatment of Undescended Testicle and Fertility Protection
The main treatment is orchiopexy, a surgery that brings the testicle down into the scrotum and fixes it there. The aim is to improve position, support future testicular function, make examination easier, and reduce some long-term risks.
When should orchiopexy be performed?
If the testicle has not descended after 6 months, early specialist evaluation is recommended. Surgery is commonly planned between 6 and 18 months, with many guidelines favoring correction before 12 months when possible and by 18 months at the latest.
How orchiopexy is performed
The surgeon mobilizes the testicle and surrounding structures, brings the testicle into the scrotum, and fixes it without tension. A palpable groin testicle may need a more direct approach, while a non-palpable or abdominal testicle may require laparoscopy or a staged plan. The method depends on testicle location, size, and blood supply.
Does early treatment fully restore fertility?
Early treatment improves the chance of preserving testicular function, but it does not guarantee normal fertility for every boy. Some risk may remain, especially in bilateral cases or when testicular development is already abnormal. Surgery should be understood as risk reduction, not a complete guarantee.
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Risks of Delaying Treatment for Undescended Testicle
Delaying treatment may increase the risk of testicular tissue damage and make long-term monitoring more difficult. Cryptorchidism is also associated with risks such as hernia, rare torsion, and later difficulty examining the testicle if it remains outside the scrotum.
Reduced sperm production after delayed treatment
The longer the testicle remains outside the scrotum, the more likely sperm-producing cells may be affected. This does not mean every child will have fertility problems, but it explains why early treatment is preferred. Evidence supports better fertility-related indicators with earlier surgery compared with delayed correction.
Undescended testicle and future testicular cancer risk
An undescended testicle is associated with increased testicular cancer risk compared with men without the condition. Surgery does not completely remove this risk, but it places the testicle where examination and follow-up are easier. Pubertal boys should be taught testicular self-awareness and to seek medical care for lumps, pain, or changes.
Can hormone treatment replace surgery?
For most cases, surgery remains the main treatment. Hormonal treatment is not a reliable routine replacement for orchiopexy and may not provide lasting descent or adequate fertility protection. Treatment should not be delayed because of unproven promises.
Fertiliv’s Approach to Cryptorchidism and Fertility Evaluation
At Fertiliv, the approach depends on age. In children, the focus is early recognition and timely referral for correction. In adult men with previous cryptorchidism and infertility, the focus shifts to semen analysis, hormone testing, testicular size, and, when needed, genetic evaluation and sperm retrieval planning.
Evaluating a child with suspected undescended testicle
The assessment should determine whether one or both sides are affected, whether the testicle is palpable, and whether there are associated issues such as hernia or small testicular size. Parents should receive clear counseling about timing without unnecessary fear.
Evaluating an adult man with previous cryptorchidism
An adult man with a history of undescended testicle and infertility should have semen analysis, hormone profile, and testicular evaluation. If severe sperm impairment or azoospermia is found, sperm retrieval methods such as TESE or Micro-TESE with ICSI may be considered in selected cases.
Planning fertility treatment for the couple
Male evaluation alone is not enough. The female partner’s age, ovarian reserve, ovulation, uterus, and tubes also matter. If previous cryptorchidism has affected sperm production, male-factor treatment can be combined with ICSI planning to determine whether sperm can be used from semen or retrieved from the testicle.
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Conclusion
An undescended testicle is a common childhood condition that may affect male fertility later in life if not diagnosed and treated on time. Early orchiopexy helps protect testicular function as much as possible and is usually recommended after 6 months if the testicle does not descend, ideally before 12 months and by 18 months at the latest when possible. Early treatment reduces risk, but it does not eliminate every fertility or cancer-related concern, especially in bilateral or severe cases.
Frequently Asked Questions: Undescended Testicle and Fertility
Does an undescended testicle always cause infertility?
No. Many unilateral cases treated early do not lead to complete infertility, but risk is higher in bilateral or late-treated cases.
When should an undescended testicle be treated?
If it has not descended after 6 months, specialist evaluation is recommended, and surgery is usually planned before 12–18 months.
Is ultrasound always needed?
No. Physical examination is the key step, and imaging should not delay specialist referral.
Can a man have children after an undescended testicle?
Yes, especially after unilateral early treatment. If semen quality is severely affected, ICSI or sperm retrieval may be discussed.
Does orchiopexy remove cancer risk completely?
No. It lowers some concerns and makes examination easier, but long-term awareness remains important.