title: Neoadjuvant gonadotropin-releasing hormone therapy before surgery may improve the fertility index in undescended testes: a prospective randomized trial.
abstract: OBJECTIVE
  Subfertility is considered the principal consequence of cryptorchidism even after timely orchiopexy. Gonadotropin-releasing hormone (GNRH) treatment appears to improve fertility later in life by inducing germ cell maturation. In a prospectively randomized trial we investigated whether preoperative GNRH therapy improves the fertility index in primary cryptorchidism.
  
  
  METHODS
  A total of 42 boys 11 to 100 months old (median 33.5) with 63 undescended testes were prospectively assigned to 2 groups during a 6-month period. Patients were randomized to receive either orchiopexy alone (21 patients) or with neoadjuvant GNRH therapy (21) as a nasal spray for 4 weeks at 1.2 mg per day. In both groups testicular biopsies were performed at the time of orchiopexy and histopathological fertility index was determined.
  
  
  RESULTS
  Mean fertility index in the group treated with GNRH before surgery was significantly higher (1.05, SD +/- 0.71) compared to the group without hormonal stimulation (0.52, SD +/- 0.39, p <0.05). The subgroup of neoadjuvant stimulated boys younger than 24 months achieved the best results compared to the age matched boys without hormonal treatment.
  
  
  CONCLUSIONS
  Neoadjuvant GNRH treatment improves fertility index in prepubertal cryptorchidism. Consequently, preoperative hormone therapy should improve fertility in adulthood. Additionally, the nasal application is well tolerated, safe and already recommended in an adjuvant setting after orchiopexy. Maximum salvage of active germinal tissue is achieved by treating cryptorchidism before the end of the first year of life.
authors.affiliation: Department of Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Schwentner
authors.forename: Josef
authors.initials: J
authors.lastname: Oswald
authors.forename: Alfons
authors.initials: A
authors.lastname: Kreczy
authors.forename: Andreas
authors.initials: A
authors.lastname: Lunacek
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Martina
authors.initials: M
authors.lastname: Deibl
authors.forename: Christian
authors.initials: C
authors.lastname: Radmayr
mesh_terms: D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007248:Infertility, Male / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D011300:Preoperative Care; D011446:Prospective Studies; D013093:Spermatogonia
chemical_list: D007987:Gonadotropin-Releasing Hormone