Hadziselimovic F (2008) Successful treatment of unilateral cryptorchid boys risking infertility with LH-RH analogue. Int Braz J Urol 34: 319–328

In boys with cryptorchidism, an impaired hormonal surge during early infancy can prevent development of type Ad spermatogonia, which causes infertility. Although the cosmetic appearance of cryptorchidism is successfully treated with early orchiopexy, many patients remain infertile. Luteinizing-hormone-releasing hormone (LHRH) analogs increase germ cell numbers, so this study evaluated the effect of the LHRH analog buserelin on fertility in boys with cryptorchidism treated by orchiopexy.

Fifteen boys with unilateral cryptorchidism underwent Schoemaker orchiopexy at a mean age of 3 years. Testicular biopsy revealed an absence of type Ad spermatogonia and fewer than 0.2 germ cells per tubular cross-section. Within 3 months after surgery these boys received buserelin 10 µg intranasal spray on alternate days for 6 months. Patients were assessed after hormonal treatment ended, and reassessed at age >18 years. Reassessment results were compared with those from 15 age-matched controls who had also undergone Shoemaker orchiopexy (at a mean age of 4 years), but who had not received buserelin.

All adult patients (mean age 19 years) were healthy, with normal sexual development, erectile function and penis length. All patients in the surgery-only group were severely oligospermic (average 1 × 106, 95% CI 0–13 × 106 spermatozoa per ejaculate); by contrast, 86% of buserelin-treated individuals were normospermic (average 90 × 106, 95% CI 53–164 × 106 spermatozoa per ejaculate in the buserelin-treated group; P = 0.000008).

This study demonstrates the successful treatment of cryptorchidism in patients at high risk of infertility. The author suggests that testicular biopsy should be routinely performed at orchiopexy to identify patients without type Ad spermatogonia.