Hypospadias and infertility

First off, hypospadias itself does not cause infertility. The topic of hypospadias and infertility comes up with more severe hypospadias where the testes are irregular and cannot produce viable sperm or due to structural abnormalities, either because of the location of the meatus (the pee hole), the sperm has trouble getting to where it needs to go, or due to existing or residual chordee (curvature of the penis), erection is difficult and/or painful. Some studies have shown that fathers of boys with hypospadias not only have higher incidence of hypospadias, but also have decreased semen quality. Most likely dads and their sons share the same susceptibility genes, but also environmental factors can’t be excluded.

Structural abnormalities and infertility

Any structural abnormalities that damage or block the testes, tubes or other reproductive structures can affect fertility in males. Cryptorchidism, which is seen in newborns where the testicles fail to descend into the scrotum, is seen with more severe hypospadias. Cryptorchidism is associated with mild to severe impairment of sperm production. With hypospadias, the urinary opening on the underside of the penis can prevent sperm from reaching the cervix.

Full correction of the urethral opening and the chordee will address the structural abnormalities, but as mamas we still wonder:

Will my son’s hypospadias affect him in the future? Will he have painful erections? Will the size of his penis bother him or affect his ability to reproduce? Will he have to try longer to conceive? And, of course regarding hypospadias and infertility, if your son’s hypospadias is severe, will his hypospadias make him infertile?

This is a tough one for us mamas. Planning for and going through hypospadias surgery is one thing, but then wondering if there will be fertility problems in the future is another thing entirely. When we were pregnant and having ultrasound after ultrasound, at one point, the techs couldn’t find testicles. After all the karyotyping and talk of ambiguous genitalia and micropenis, the thought that he may be born with no testicles was heartbreaking. In more severe hypospadias, sometimes one or both testicles are undescended at birth (cryptorchidism), however hypospadias and undescended testicles can be a sign of an intersex condition or a chromosome disorder, such as Klinefelter syndrome in which an additional X chromosome exists. I recall talking to my doctor at that time about what the future will hold for men who were infertile due to irregular or non existent testicles.

Working to build artificial testicles

What I found is there are currently researchers under a grant from the National Institute of Environmental Health Sciences working to build artificial testicles that could produces human sperm. This would allow infertile men to conceive children. However, the use of stem cells is tricky.

Some researches have tried to grow sperm from cells via stem cell, but lacking the complete “testicle environment” with all of its natural home-like components, the cells stop short of completing the necessary steps – they go through 9 or 10 out of 12. A team led by Paul Turek, MD at a San Francisco start-up, Mandalmed, says the solution is to build the sperm’s own incubator, mimicking the biology of the male reproductive system. If an artificial, sperm-producing testicle could be created, it wouldn’t be perfect. It would likely last only as long as it takes to go through one cycle of sperm production, and afterwards another one would have to be created.

The current work on the artificial testicle could someday be used in tandem with in-vitro fertilization and is hoped to be completed 5 to 7 years. For those of us with babies now, there’s no telling what they’ll be able to do twenty years down the road.

 

Best of luck to you all – Christina

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