title: Mesh hernia repair and male infertility: a retrospective register study.
abstract: BACKGROUND
  Previous studies have suggested that the use of mesh in groin hernia repair may be associated with an increased risk for male infertility as a result of inflammatory obliteration of structures in the spermatic cord. In a recent study, we could not find an increased incidence of involuntary childlessness. The aim of this study was to evaluate this issue further.
  
  
  METHODS
  Men born between 1950 and 1989, with a hernia repair registered in the Swedish Hernia Register between 1992 and 2007 were cross-linked with all men in the same age group with the diagnosis of male infertility according to the Swedish National Patient Register. The cumulative and expected incidences of infertility were analyzed. Separate multivariate logistic analyses, adjusted for age and years elapsed since the first repair, were performed for men with unilateral and bilateral repair, respectively.
  
  
  RESULTS
  Overall, 34,267 men were identified with a history of at least 1 inguinal hernia repair. A total of 233 (0.7%) of these had been given the diagnosis of male infertility after their first operation. We did not find any differences between expected and observed cumulative incidences of infertility in men operated with hernia repair. Men with bilateral hernia repair had a slightly increased risk for infertility when mesh was used on either side. However, the cumulative incidence was less than 1%.
  
  
  CONCLUSIONS
  Inguinal hernia repair with mesh is not associated with an increased incidence of, or clinically important risk for, male infertility.
authors.affiliation: Department of Surgery, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden. magnus.hallen@skane.se
authors.forename: Magnus
authors.initials: M
authors.lastname: Hallén
authors.forename: Johan
authors.initials: J
authors.lastname: Westerdahl
authors.forename: Pär
authors.initials: P
authors.lastname: Nordin
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
mesh_terms: D000328:Adult; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007248:Infertility, Male / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult