BACKGROUND: Inguinal hernia repair and orchiopexy are common pediatric urologic procedures, with bilateral interventions potentially impacting future fertility. Limited data exists regarding the impact of bilateral inguinal hernia repair on future fertility in pediatric patients, limiting providers’ ability to counsel patients about these risks. This is not true of patients undergoing bilateral orchiopexy for bilateral undescended testes, where there is a known risk of future infertility. We aimed to assess the impact of bilateral inguinal hernia repair (B/L IHR) on male fertility and paternity. We hypothesize that (B/L IHR) in pediatric patients may have a significant impact on future fertility and paternity.
METHODS: We conducted a case-control study utilizing the Utah Population Database (UPDB), encompassing demographic, medical, and residential data for Utah residents, capturing over 90% of Utah’s pediatric poplation. Cases comprised males who had B/L IHR before age 18 from 1996-2022, matched with controls for age and county of residence. Controls included a group without a history of pediatric B/L IHR or BO (matched 3:1) and a group of males who underwent pediatric BO (matched 1:1), a known risk for male infertility. Primary outcomes included male factor infertility diagnosed through ICD-09/-10 codes and paternity determined using UPDB family relationship data. Multivariate Cox proportional hazards models assessed the association between BO or B/L IHR and infertility or paternity. For the infertility model, patients were followed from either age 18, first residence in Utah, or 1996, whichever was later, until receiving an infertility diagnosis, with exclusions for prior infertility diagnoses. Birth decade served as a strata. For the paternity model, patients were followed from age 18 or first residence in Utah, until appearing as a father on a birth certificate, with exclusions for unidentified partners or prior children before moving to Utah or age 18. Partner infertility was a covariate, with birth decade as a strata.
RESULTS: The study included 1,156 B/L IHR cases, 5,780 non-surgical controls, and 494 BO cases. The cohort was predominantly white (87.8%) and non-Hispanic (68.4%), with 20.5% having at least one child. Infertility diagnoses were more frequent among B/L IHR and BO cases compared to non-surgical controls. Multivariate Cox regression showed higher likelihoods of infertility diagnosis for B/L IHR cases (HR=2.07, [1.20-3.58], P=0.01) and BO cases (HR=2.01, [1.03-3.94], P=0.04) versus non-surgical controls. No significant trend in paternity likelihood was observed for B/L IHR cases (HR=0.97, [0.84-1.13], P=0.7), while BO individuals showed a trend toward reduced paternity (HR=0.84, [0.70-1.02], P=0.08) compared to controls.
CONCLUSIONS: Pediatric bilateral inguinal hernia repair and bilateral orchiopexy elevate infertility rates compared to controls, with only bilateral orchiopexy suggesting a trend toward decreased paternity. The risk of male-factor infertility post-pediatric bilateral inguinal hernia repair is notably higher compared to controls, with a hazard ratio akin to that of patients undergoing bilateral orchiopexy.
