title: Male reproductive tract abnormalities: more common after assisted reproduction?
abstract: BACKGROUND
  In this era of increased use of assisted reproduction (AR) techniques, the prevalence rates of hypospadias, cryptorchidism, poor semen quality have been increasing in parallel with a rising incidence of testicular cancer. It is suggested that these problems result from the disruption of gonadal development during fetal life causing the testicular dysgenesis syndrome (TDS).
  
  
  OBJECTIVE
  The aim of our study was to evaluate the influence of conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), on the development of male genital tract abnormalities.
  
  
  METHODS
  We analyzed a cohort of 15,206 neonates born from January 1, 1999 through December 31, 2008 at the Department of Obstetrics and Gynecology, Medical School, University of Pécs, including 890 children (5.9%) born after IVF or ICSI. We examined the association between these AR methods and developmental abnormalities of the genital tract (hypospadias, cryptorchidism), after controlling for potential confounding factors, such as prematurity, low birthweight and twinning.
  
  
  RESULTS
  Preterm birth and low birthweight are risk factors for hypospadias and cryptorchidism (p<0.001), twinning increases the risk of hypospadias (p<0.001). ICSI was revealed as a risk factor for hypospadias in singletons (OR: 3.190, 95%CI: 1.266-8.042) and in normal birthweight (>2500 g) infants (OR: 3.966, 95%CI: 1.193-13.181, respectively). Similar but not nonsignificant trends were seen for cryptorchidism.
  
  
  CONCLUSIONS
  IVF and ICSI, by increasing the risks of prematurity, low birthweight, and multiple gestation, are indirect risk factors for developing male genital malformations. In infants with normal birhtweight or from singleton pregnancies, ICSI is a specific risk factor for hypospadias.
authors.affiliation: Department of Obstetrics and Gynecology, Medical School, University of Pécs, H-7624 Pécs, Edesanyák útja 17., Hungary. simone.funke@aok.pte.hu
authors.forename: Simone
authors.initials: S
authors.lastname: Funke
authors.forename: Edina
authors.initials: E
authors.lastname: Flach
authors.forename: István
authors.initials: I
authors.lastname: Kiss
authors.forename: János
authors.initials: J
authors.lastname: Sándor
authors.forename: Gabriella
authors.initials: G
authors.lastname: Vida
authors.forename: József
authors.initials: J
authors.lastname: Bódis
authors.forename: Tibor
authors.initials: T
authors.lastname: Ertl
mesh_terms: D015331:Cohort Studies; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006801:Humans; D006814:Hungary; D007021:Hypospadias / Q000209:etiology*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011272:Pregnancy, Multiple; D047928:Premature Birth; D012307:Risk Factors; D055101:Semen Analysis; D013733:Testicular Diseases / Q000209:etiology*