title: Hormonal therapy using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review.
abstract: OBJECTIVE
  Gonadotropin releasing hormone(GnRH) as an adjunct to orchidopexy for the treatment of cryptorchidism is still controversial. Present evidences were studied through a meta-analysis of comparative clinical trials.
  
  
  METHODS
  Systematic literature search was done up to September 30, 2013. Studies were independently appraised by two reviewers. Continuous data of fertility indices were extracted as weighted mean difference (WMD) and standard deviation (SD); while nominal data of fertility indices were extracted as relative risk (RR). Random effects model was used to analyze the pooled effect estimates. Inter-study heterogeneity and publication bias were assessed. PROSPERO Protocol registration (CRD42013004922).
  
  
  RESULTS
  Ten eligible studies were included. The pooled effect estimates showed that cryptorchid children treated with GnRH when compared with controls, have significantly increased germ cell per tubule (WMD: 0.35; 95% CI 0.07-0.62, P=0.01) and increased RR to have normal value of germ cell per tubule (RR: 2.86; 95% CI 1.73-4.71, P<0.0001). Inter-study heterogeneity was noted, source identified with subgroup analysis. Publication bias was not evident. No GnRH related adverse events were reported in all studies.
  
  
  CONCLUSIONS
  Evidence suggests that a subset of boys with cryptorchidism may benefit from GnRH as adjunctive to orchidopexy in improving the fertility index. However, future studies are recommended to specifically identify subgroup characteristics of cryptorchidism that will clearly benefit from the treatment.
authors.affiliation: Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines. Electronic address: auhc_ekim@yahoo.com.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chua
authors.affiliation: Department of Preventive and Community Medicine, St. Luke's College of Medicine, Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Mendoza
authors.affiliation: Department of Surgery, Ateneo Medical School, Philippine General Hospital, Manila, Philippines.
authors.forename: Michael John V
authors.initials: MJ
authors.lastname: Gaston
authors.affiliation: Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines.
authors.forename: Saturnino L
authors.initials: SL
authors.lastname: Luna
authors.affiliation: Institute of Urology, St. Luke's Medical Center, Department of Urology, National Transplant and Kidney Institute, Quezon City, Philippines.
authors.forename: Marcelino L
authors.initials: ML
authors.lastname: Morales
mesh_terms: D002648:Child; D003456:Cryptorchidism / Q000188:drug therapy* / Q000503:physiopathology; D005298:Fertility / Q000187:drug effects*; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D008297:Male
chemical_list: D007987:Gonadotropin-Releasing Hormone
keywords: Cryptorchidism; Fertility index; Gonadotropin releasing hormone; Meta-analysis; Sperm parameters; Systematic review