Introduction: Historically, infertility was women’s burden to bear. In 1659, John Tanner suggested the male seed as a contributing factor, and it has taken several centuries for scholars to appreciate how genital pathologies impact male fertility. This review explores fertility preservation (FP) in the context of cryptorchidism, varicocele, and malignancy.
Methods: A comprehensive review of historical and medical literature was undertaken.
Results: Cryptorchidism
Baron Albrecht von Haller described cryptorchidism in the 1700s, piquing the interest of John Hunter who suggested in 1786 that cryptorchidism had functional consequences. Treatment evolved from castration to the first orchidopexy by James Adams in 1871, which was complicated by fatal erysipelas. Using antiseptic techniques, Thomas Annandale performed the first successful orchidopexy in 1877. In the 1920s, the study of functional changes in cryptorchidism gained traction, and in the 1970s Gerd Ludwig found higher fertility rates if surgical correction was performed before age two. Despite timely interventions, >20% of patients may be infertile. Testicular biopsy may predict which patients benefit from additional FP technologies.
Varicocele
Repair of varicoceles performed with horse hair ligatures was described by Cornelius Celsus (25BCE - 50CE). Early treatments were numerous and inventive but served to manage pain and swelling. In 1856, Thomas Curling suggested an association between varicoceles and functional capacity of testicles. William Tulloch performed varicocele repair to treat infertility in 1952; his azoospermic patient subsequently had increased sperm concentration and eventually fathered a child. From 1970 onward, varicocelectomies became more common and techniques ranged from sclerosis of veins to microscopic-assisted techniques.
Malignancy
As cancer survival improves, oncofertility has emerged to address impaired reproductive function after cancer therapies. References to cryopreservation date back to the 1600s. While John Hunter artificially inseminated the wife of a man with hypospadias in 1790, it wasn’t until over a century later that cattle breeders drove scientific investigation of cryopreservation for bull sperm. The first human live birth using frozen sperm was in 1953, and since then new assisted reproductive technologies—including tissue preservation for pre-pubertal boys—are changing the landscape in cancer survivorship.
Conclusions: Over the last century, our understanding of genital pathologies impacting male fertility and approaches to FP have vastly evolved.
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