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Prof. Dr. Ali Avanoğlu
Undescended Testicle • Adolescents and adults

Does an Undescended Testicle Cause Infertility? Fertility and Paternity

The most common question asked by men with a history of an undescended testicle is whether they will be able to have children. The answer differs greatly between unilateral and bilateral cases: in unilateral cases the paternity rate is close to that of the general population, while in bilateral cases it drops markedly. This page explains the reasons, the effect of timing, and the path of evaluation in adulthood.

Who this is forFamilies and adults concerned about reproductive capacity, for themselves or their child
Reading≈5 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of undescended testicle.Read the full treatment overview on the hub page
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in the inguinal canal · bilateral
01 · Why should the testicle be in the scrotum?02 · Unilateral undescended testicle03 · Bilateral undescended testicle04 · The effect of timing05 · Evaluation and options in adulthood
In brief5 madde
  • Why should the testicle be in the scrotum?: The testicle is designed to work in an environment 2–3 degrees cooler than body temperature; the scrotum provides this temperature regulation.
  • Unilateral undescended testicle: In men with a unilateral history, the healthy other testicle compensates for most of the production.
  • Bilateral undescended testicle: In bilateral cases, since both testicles have remained in a warm environment, there is no healthy testicle to compensate.
  • The effect of timing: Testicular tissue studies have shown that performing orchiopexy around one year of age better preserves germ cell counts, and that the loss increases the longer…
  • Evaluation and options in adulthood: Definitive evaluation is done in adulthood.
01

Why should the testicle be in the scrotum?

The testicle is designed to work in an environment 2–3 degrees cooler than body temperature; the scrotum provides this temperature regulation. A testicle that remains in the abdomen or groin is continuously exposed to body temperature.

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  • The precursor cells of sperm (germ cells) gradually decrease at this temperature; the loss begins as early as the first year after birth and progresses over the years. Testosterone-producing cells are more heat-resistant; this is why hormone production is usually preserved in men with an undescended testicle, while sperm production can be affected.
  • This fact underlies the entire treatment logic: orchiopexy (fixing the testicle in the scrotum) is done not for appearance, but to preserve reproductive capacity and make the testicle accessible to examination.
02

Unilateral undescended testicle

In men with a unilateral history, the healthy other testicle compensates for most of the production. Long-term studies report a paternity rate close to the general population, around 90 percent; the difference from the population rate is small.

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  • On sperm analysis, the unilateral group may show a slight reduction in sperm count and motility; however, this usually does not translate into a lower paternity rate. The health of the other testicle is therefore decisive and an integral part of follow-up.
  • Surgical timing also matters in unilateral cases; orchiopexy performed within the 6–12 month window recommended by guidelines has been shown to better preserve germ cell counts.
03

Bilateral undescended testicle

In bilateral cases, since both testicles have remained in a warm environment, there is no healthy testicle to compensate. The paternity rate drops markedly; the literature reports a figure of around 60 percent, and significantly reduced sperm counts or a complete absence of sperm (azoospermia) is more common on sperm analysis.

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  • In this group, early surgery is the single most important protective factor. Pre-pubertal hormone evaluation and, in selected cases, endocrine treatment aimed at supporting reproductive potential are assessed jointly with pediatric urology and endocrinology; hormone therapy is not routinely recommended in unilateral cases for the purpose of bringing the testicle down.
  • Bilateral intra-abdominal testicles and accompanying findings such as hypospadias require additional genetic and hormonal evaluation; in these cases, fertility planning begins to be discussed at an early age.
04

The effect of timing

Testicular tissue studies have shown that performing orchiopexy around one year of age better preserves germ cell counts, and that the loss increases the longer surgery is delayed. This is the main rationale behind the guideline recommendation of 6–12 months, at the latest by 18 months.

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  • Orchiopexy performed late is not without meaning either: the testicle descends into the scrotum, hormone-producing tissue is preserved, and examination becomes possible. However, the gain in terms of sperm production decreases with age; the decision to operate in adolescence and adulthood is made together with reasons beyond reproduction.
  • Testicle size after surgery is a rough indicator of reproductive capacity; a testicle that remains markedly smaller than the other one in adolescence is addressed with hormone testing and, if needed, sperm analysis.
05

Evaluation and options in adulthood

Definitive evaluation is done in adulthood. Sperm analysis (count, motility, morphology) is the first step; if the result is borderline, it is repeated a few weeks apart. The hormone profile — FSH, LH, testosterone, and inhibin B when needed — shows the testicle's production capacity; a high FSH points to germ cell loss.

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  • For couples with low sperm parameters, assisted reproductive techniques (insemination, IVF, ICSI) are used with high success rates. Even in azoospermia, retrieving sperm from testicular tissue (micro-TESE) may be possible; this is an important option for men with a bilateral history.
  • On this team, pediatric urology and adult urology work side by side; the fertility evaluation of an adult who had surgery in childhood is carried out under the same roof, together with reproductive medicine when needed.
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Frequently asked questions
My son had unilateral surgery; will he be able to have children in the future?
Most likely, yes. In a unilateral history, the paternity rate is reported to be close to the general population, around 90 percent. A healthy remaining testicle and regular follow-up are the foundation of this outcome; a definitive assessment is made in adulthood through sperm analysis.
Is there no hope in bilateral cases?
No, quite the opposite — with early surgery and regular follow-up, paternity is possible in most bilateral cases; although the rate is lower than in the general population, it is around 60 percent. Even in cases with no sperm found, sperm can be retrieved with micro-TESE, and assisted reproductive techniques are used.
When should sperm analysis be done?
The first assessment can be done once puberty is complete, usually around age 18; it is especially recommended for a bilateral history. It is repeated at any age when the desire for children arises or if there is concern.
Is sperm freezing necessary?
For young adults with a bilateral history and borderline sperm parameters, the option of freezing sperm for the future can be discussed. The decision is made individually based on the sperm analysis result and the patient's plans.
Can a man with one testicle have children?
Yes, he can; a single healthy, well-functioning testicle in the scrotum is sufficient for both hormone production and reproduction in most men. Sperm count may be found lower than in men with two testicles, but this does not eliminate the chance of paternity in most cases. For this reason, protecting the remaining testicle from injury, torsion, and hernia, and monitoring it regularly after puberty, is important.
←Previous • Adolescents and adultsOrchiopexy or Orchiectomy?Next • Adolescents and adultsUndescended Testicle and Testicular Cancer Risk→
Related pagesFull index →
BasicsUnilateral and Bilateral Undescended TesticleAbout one-third of undescended testicle cases are bilateral, and this distinction changes the treatment plan. In a unilateral case, the other testicle is healthy and the paternity rate is close to that of the general population; in a bilateral case, both testicles are affected, so reproductive potential is more significantly affected, and hormonal evaluation and early surgery become even more important.Surgery in childrenWhen Is Surgery Needed? TimingFor undescended testicle, the question of “when” matters as much as “how.” Guidelines define the first six months as a watch-and-wait period, with 6–12 months as the target window for orchiopexy (fixing the testicle in the scrotum); this page explains the reasoning behind this timeline and its exceptions.Surgery in childrenHormone Therapy‘Can’t it be brought down with an injection or a spray?’ is one of the questions families ask most often. Hormone therapy (hCG or GnRH) is not routinely recommended for bringing down a unilateral undescended testicle; success rates are low, and the testicle often retracts again. In bilateral and selected cases, it is a separate matter, evaluated together with endocrinology to support reproductive potential.Adolescents and adultsUndescended Testicle in AdultsIn adults, an undescended testicle most often comes to light during an infertility workup, as groin swelling, or as an incidental finding on imaging. At this age, the decision is guided by different principles than in infancy: the goal is to weigh the testicle's function, the condition of the other testicle, the desire for children, and testicular cancer risk together. This page explains the evaluation steps and decision factors for the adult patient.
Undescended Testicle topic clustersMain treatment page →
Basics 7Diagnosis and evaluation 6Surgery in children 10Special situations 4After surgery 6Adolescents and adults 6Follow-up 3
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