Prospects for fertility in patients born with genitourinary anomalies

Purpose: The effect of congenital genitourinary anomalies on fertility and the impact of current therapies are reviewed. Materials and Methods: The literature of each of the 2 components was used to define the present status and to make proposals for future management. Results: Infertility may be caused by gonadal failure (intersex states), fa ilure of sperm transport (exstrophy) or both (bilateral undescended testes) . In some conditions it is uncertain whether there are any fertility proble ms despite an identifiable genital problem. In cases of unilateral undescen ded testis the fertility rate may be unaffected by surgery and be no differ ent from that in the normal population. Techniques of in vitro fertilizatio n, particularly intracytoplasmic sperm injection, have allowed previously u ntreatable patients to become parents. Successful pregnancies in patients w ho had the prune belly syndrome and Klinefelter's syndrome have been report ed in the last year. Conclusions: Prospects for fertility with current techniques and those that might be discovered in the next 20 years should strongly influence decisio ns about the treatment of infants and children.