If your baby’s pediatrician notices an undescended testicle—otherwise known as cryptorchidism—they might have told you that this is a common condition affecting up to 30% of premature infants yearly.
Undescended testicles tend to develop on their own and fully descend by 3 months or be corrected with surgery by the time the infant is one year old.
However, it must be noted that individuals born with cryptorchidism are subject to increased risk for certain medical conditions. It’s definitely beneficial to know why undescended testicles happen and what to keep an eye out for down the road.
What is an undescended testicle at birth or cryptorchidism?
Cryptorchidism happens when one or both testicles haven’t fully descended into the scrotum (or the patch of skin below the penis) that houses the testicles at birth. In many cases, the testicles descend into the correct positions within three months of infancy. However, a very small percentage of cases will require corrective surgery.
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What causes cryptorchidism?
Babies born prematurely are at a heightened risk of having an undescended testicle. The causes of cryptorchidism in babies delivered after a regular pregnancy are harder to determine. It is believed that genetics, environment, and maternal health factors affect testicular and hormonal development.
The following conditions have the most compelling evidence linked to a heightened risk of developing cryptorchidism:
- Premature birth, indicating a lack of time for testicles to fully descend into the scrotum
- Low birth weight
- Family history of genital development issues, including cryptorchidism
- Conditions that interfere with development (e.g., Down’s Syndrome)
- Smoking cigarettes while pregnant
- Gestational diabetes
- Preeclampsia
Other suspected cryptorchidism risks include heavy alcohol use during pregnancy and exposure to pesticides that may inhibit genital development and full testicular descent.
How is cryptorchidism diagnosed?
Testicles form in a male infant’s abdomen during gestation and descend into the scrotum by birth. If the testicles recede, there will be a noticeable section of the scrotum where the testicles should be found.
Diagnosis is quite simple: a pediatrician or pediatric urologist may be able to spot undescended testes by feeling them. Sometimes, testicles can get stuck in the tube that allows them to descend. If it isn’t felt right away, the testicle might be higher up the abdomen. An ultrasound may help locate it so it can be diagnosed.
Cryptorchidism may be mistaken for retractile or ascending testicles.
What are retractile and ascending testicles?
Occasionally, a testicle that might be visible at birth may disappear. That indicates that the infant may have a retractile testicle, which can be corrected by moving it into place. Retractile testicles may change positions, but they will usually fully descend and remain in their proper place before puberty hits.
On the other hand, a testicle present at birth may return to the pelvic region and remain there. This condition is called an ascending testicle in medical circles that requires surgery to correct.
How is an undescended testicle treated?
Undescended testicles are treated with corrective surgery, known as an orchidopexy, which involves moving the affected testicle(s) in its proper position. Using a laparoscopy to guide the surgery or find the missing testes has been found to be a better option when undergoing orchidopexy.
The American Urological Association (AUA) advises doctors to perform this surgery on infants between 6–18 months. However, most experts recommend surgery at six months to protect the infant’s reproductive system. The longer the testicles stay in the body, the greater the chance of losing reproductive function.
Undergoing surgery may also prevent the twisting of the spermatic cord, preventing blood from flowing into the testicle and leading to its permanent loss. This twisting of the spermatic cord, known as testicular torsion, is more likely to happen if a testicle is located in the groin.
What are the complications of having an undescended testicle at birth?
Leaving an undescended testicle untreated and inside the body even for just a few months as an infant may increase the risk of testicular cancer and infertility in the future.
Reduced reproductive function/fertility
Undergoing corrective surgery as an infant improves fertility outcomes later in life. Individuals with undescended testicles left untreated face an 89% chance of being infertile. That number becomes 35% in men who received corrective treatment as infants. The infertility rate in individuals with only one undescended testicle is 10%
Moreover, corrective surgery may raise sperm counts even when treatment happens after 24 months into the infant’s life. But in general, the earlier the treatment, the better the outcome is for fertility. Many men with undescended testicles at birth corrected with surgery go on to have their own children.
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Increased testicular cancer risk
Having a history of cryptorchidism is one of the several known risk factors for testicular cancer. When cryptorchidism is treated before puberty, an individual’s chances of developing testicular tumors increase by three times that of the general public. Waiting to treat it after puberty increases that risk even higher.
For those who receive treatment before puberty, age doesn’t seem to affect the risk of developing testicular cancer, remaining the same regardless of when treatment occurs early in infancy or later in childhood.
Healthcare providers often diagnose a tumor known as a seminoma in cases of untreated cryptorchidism. It’s a highly treatable condition when caught at an early stage. Therefore, individuals who receive treatment for undescended testicles may find it useful to learn to do a testicular self-exam to catch tumors early.
A testicular self-exam consists of examining each testicle separately, holding it between your thumbs and fingers, and rolling it gently, feeling for nodules or hard lumps.
What should you ask your healthcare provider?
If you have a family history of cryptorchidism or testicular cancer, it’s a good idea to consult your healthcare provider about how to spot tumors early.
And if you were born with cryptorchidism or parenting a child who has it, your healthcare provider will be able to guide you towards fertility-boosting resources and answer your questions about this quite common condition.
