Introduction: Limited, small-scale studies have revealed that men with proximal hypospadias (HS) or with other signs of undermasculinisation (i.e. complex HS) are at risk of reduced fertility and/or impaired testicular hormone synthesis. However, the extent of this phenomenon and if milder forms of isolated HS are also affected, remains unclear.
Aims: To explore reproductive hormones and semen quality of young men (16-21 years old) born with all forms of non-syndromic HS in comparison to healthy controls.
Methodology: Cross-sectional assessment was performed at Ghent University Hospital and Wien Medical University (ongoing). Blood sampling was done between 8:00 and 9:00 for total and free testosterone, LH, FSH and Inhibin B measurement. Participants were asked to give two semen samples for a spermiogram, according to the WHO 2010 criteria. Statistical analysis was performed using IBM SPSS© 25.0 using an unpaired Student t-test or Mann Whitney-U test as appropriate.
Results: A total of 153 HS (108 distal, 45 proximal) and 42 controls have currently entered the study. No differences in free and total testosterone and DHT levels were found between distal or proximal HS, or between isolated or complex HS, as compared to controls. FSH levels were higher and Inhibin B levels lower in complex HS as compared to isolated HS and controls (FSH: P=0,011 and P=0,005; Inhibin B P=0,001 and P=0,008, respectively). Azoospermia was found in 6 (4,3%) HS. Oligozoospermia was present in 24 (17,3%) HS and 1 (2,4%) control. According to the WHO 2010 criteria, 60/139 (43,2%) HS had a normal spermiogram as compared to 24/42 (57,1%) controls. In controls, mild asthenozoospermia and teratozoospermia were the most common causes of abnormalities. No difference in semen concentration was found between distal and proximal HS (P=0,557). However, both groups had lower sperm concentrations as compared to controls (distal: P=0,022; proximal: P=0,040). Men born with complex HS had lower semen concentration as compared to men who had isolated HS and controls (P=0,007 and P<0,001, respectively).
Conclusion: In our cohort, over 20% of men born with HS have reduced semen quality. In contrast to previous studies, no difference in semen concentration was found between proximal and distal HS. However, complex HS was associated with lower semen concentrations. No difference in testosterone or LH levels was found between HS and controls.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology