Hormonal therapy for the subfertility of cryptorchidism

Background: The subfertility of cryptorchidism correlates with severely red uced total germ cell counts in prepubertal testicular biopsies of undescend ed testes. Reduced total germ cell counts are associated with defects in th e two prepubertal steps in maturation and proliferation in germ cells: firs t, the transformation of the fetal stem cell pool (gonocytes) into the adul t stem cell pool (adult dark spermatogonia) at two to three months of age a nd, second, the transformation of adult dark spermatogonia into primary spe rmatocytes (meiosis) at 4-5 years. The defects in maturation are associated with blunting of the normal surges in gonadotropins and testosterone. Prep ubertal treatment with gonadotropin-releasing hormones would theoretically trigger normal germ cell maturation and proliferation and thereby improve t otal germ cell counts and improve fertility. Prepubertal treatment of crypt orchidism with the GnRH analogue Buserelin has resulted in improved total g erm cell counts and improved spermiograms. The purpose of this report is to describe the results of treatment of cryptorchidism with the GnRH analogue Naferelin. Patients: Twelve boys with cryptorchidism, 6 unilateral and 6 b ilateral, and severely reduced germ cell counts in testicular biopsies were treated with Naferelin following successful orchidopexy and bilateral test icular biopsies. Response of the total germ cell counts was assessed in fol low-up bilateral biopsies within 5 months of completing the hormonal therap y. Results: Eight of the 12 boys (5 of the 6 with unilateral and 3 of the 6 with bilateral cryptorchidism) showed improvement in the total germ cell c ounts in one or both testes. All 8 had a poor prognosis for fertility pre t reatment and a good prognosis for fertility posttreatment. Of the 5 with un ilateral cryptorchidism who improved, 2 showed improvement in both testes; and 3, only in the contralateral descended testes. All 3 of the boys with b ilateral cryptorchidism who improved showed improvement in both testes. Tes tes with absence of germ cells and older patients tended to show no improve ment. Of the 6 contralateral descended, 5 (83%) improved, and of the 18 und escended testes, 8 (44%) improved. Conclusions: In this preliminary study, Naferelin therapy appears to induce improvement in the total germ cell coun ts and the prognosis for future fertility in 75% of patients. Copyright (C) 2001 S. Karger AG, Basel.