We Have Questions: Fertility and Orchiectomies

Men may undergo an orchiectomy, the surgical removal of one or both testicles, for a number of reasons, including to treat or prevent testicular, prostate or even breast cancer, according to the Cleveland Clinic.

When it comes to fertility and sperm production, it would be reasonable for men to believe the removal of one testicle could cause some major problems. While a bilateral orchiectomy, the removal of both testicles, makes it impossible to produce sperm, the removal of only one testicle (unilateral orchiectomy) doesn't necessarily result in a tremendous dropoff in production for otherwise healthy men.

In a paternity study published in 2005 in the Journal of the National Cancer Institute, testicular cancer patients who received an orchiectomy and surveillance as their primary treatments, and attempted conception, had a 92 percent paternity rate. Additionally, Orchid, a United Kingdom-based charity supporting male cancer patients, suggests there's no discernable decline in fertility after a unilateral orchiectomy.

So while available data and information indicate the removal of a testicle shouldn't cause fertility issues, the perception persists. To shed some light on the topic, we sent a few questions to Dr. Sanaz Ghazal, M.D., the co-founder and medical director of RISE Fertility, and a board-certified fertility specialist in Orange County, California. During an email interview, Ghazal spoke about fertility issues in general, what men with one testicle should know, and whether their fertility journeys are any different from those of men with two testicles.

How often do men reach out to you regarding fertility troubles?

Male-factor infertility is actually quite common. In fact, males alone account for about one-third of infertility cases and are a contributing factor in another 20 to 30 percent of cases.

What are the first things you look and test for when it comes to potential fertility troubles?

To uncover the potential causes of a patient's infertility, I begin with a thorough medical history to look for possible risk factors and recommend a semen analysis, which assesses the health and quality of the sperm. This information is used to determine whether any additional testing or evaluation is needed and helps to develop a personalized fertility plan for the patient.

How often do you come across patients with one testicle, and how big of a difference does that make when diagnosing fertility issues?

Regardless of the reason for orchiectomy, or the removal of a testicle, the mainstay of evaluating fertility concerns in men includes a thorough medical history and semen analysis. Understanding the clinical indication for orchiectomy and any associated procedures or treatments is also important in order to determine the impact, if any, on a man's fertility.

Are fertility issues common in men with one testicle?

Most men who have only one testicle will not experience a significant change in their fertility, but it's still important to do an evaluation.

Are there natural ways for men with one testicle to increase motility?

The same strategies to improve sperm health also apply to men with one testicle. Maintain a healthy body weight, quit smoking, eat a well-balanced diet, get regular exercise, get any medical conditions like diabetes under good control and take a daily multivitamin.

What are options for men with one testicle who can't use the above methods to improve fertility?

There are several strategies that can be used for men with compromised fertility. In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is an effective technique for addressing male-factor infertility. There are also methods of extracting sperm directly from the testicle if needed.

What are the most common issues with fertility overall? Generally, what are the ailments that cause infertility the most?

In couples with infertility, female factors account for about one-third of the cases, male factors are the sole cause in another one-third of cases, and in [the other] one-third of cases, it's a combination of male and female factors. In women, the most common causes of infertility include ovulatory dysfunction, uterine and tubal pathology, and unexplained infertility.