Men who are born with undescended testicles have a higher risk of male infertility. The majority of men who were born with one undescended testicle will still be fertile, but there will often be a measurable difference in their sperm counts. Over half of men born with both testicles undescended will suffer infertility. In some cases there will be no sperm in the semen at all. An undescended testicle is usually diagnosed in infancy and surgically corrected at that time. The sooner it is corrected the more likely sperm production will be protected but when the condition is on both sides, early correction still does not guarantee future fertility. Men who never had surgical correction may benefit from surgical correction even later in life but improvement is certainly not guaranteed. For men with a history of undescended testicles that have been surgically corrected, there is usually no way to make the sperm production better, however in cases where the sperm counts are zero, sperm retrieval surgery can allow the specialist to find sperm within the man’s testicle to use for in-vitro fertility with intracytoplasmic sperm injection. In cases where sperm is present but too low to cause a natural pregnancy, intrauterine insemination or in-vitro fertility may be the solution. Men with this condition should be screened for low testosterone.
Men who had hernias as infants or children will have had surgery to correct the hernias. The vas deferens which transports the sperm from the testicles travels in the same area as the hernia and can be accidentally injured from the hernia surgery. If this happens on one side the other side usually allows enough sperm flow to allow the man to stay fertile, but if it happens on both sides the man will have no sperm in his semen. Sperm retrieval surgery can be performed and the sperm can be used with in-vitro fertility ICSI. Microsurgical reconstruction can also be attempted to allow for natural conception.
Men born with congenital anomalies involving the male reproductive system, such as bladder exstrophy/epispadias (a condition in which the bladder is exposed through the abdomen at birth), can have difficulty ejaculating normally even though their sperm production is normal. The ejaculatory ducts may be obstructed or retrograde ejaculation may occur.
Men with childhood malignancies requiring chemotherapy have a high risk for infertility. If sperm is present in the semen but very low, in-vitro fertility will be the solution. If sperm is absent in the semen then sperm retrieval surgery may find sperm to use with IVF-ICSI.
Men who had mumps with inflammation of the testicles during puberty may have severely low or absent sperm counts which may be treatable with IVF with or without sperm retrieval surgery.