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11–14 APRIL, 2018, HELSINKI, FINLAND
11:48–11:51
S8-2 (PP)
★
FERTILITY IN HYPOSPADIAS: A NATIONWIDE REGISTER-
BASED COHORT STUDY WITH SIBLING ANALYSIS
Anna SKARIN NORDENVALL
1
, Christina NORRBY
2
, Qi CHEN
2
, Louise FRISÉN
3
,
Anna NORDENSTRÖM
1
, Catarina ALMQVIST
2
and Agneta NORDENSKJÖLD
1
1) Karolinska Institutet, Department of women's and children's health, Stockholm, SWEDEN - 2) Karolinska Institutet,
Department of Medical Epidemiology and Biostatistics, Stockholm, SWEDEN - 3) Karolinska Institutet, Department
of Clinical Neuroscience, Stockholm, SWEDEN
PURPOSE
Fertility in men with hypospadias may be impaired due to anatomical, surgical or etiological fac-
tors and associated conditions. Fertility is further influenced by sociocultural and genetic factors,
often shared within families. Only a few previous studies have investigated birthrates in men
with hypospadias. The aim of this study was to evaluate fertility in men born with hypospadias by
register-based data.
MATERIAL AND METHODS
Population-based cohort of 1.2 million men born in Sweden between 1964 and 1998, identified
through national demographic and healthcare registers. Each individual was followed from 15 years
of age to first outcome event, emigration, death, or 31 December 2013. Associations between being
born with hypospadias and 1) being the biological father of children, 2) conceiving through assisted
reproductive technologies and 3) receiving a diagnosis of male infertility, were investigated in the
whole cohort with Cox proportional hazard models, expressed as hazard ratios (HRs) with 95 %
confidence intervals (CIs). A stratified proportional hazard model, conditional on sibling group, was
used to estimate the effects of shared familial confounding. Additional sensitivity analyses on the
effect of associated malformations, cryptorchidism and psychiatric illness were conducted.
RESULTS
Men with hypospadias, as an aggregate, had a lower probability of having biological children (ad-
justed HR 0.87, 95 % CI 0.83 to 0.92). A significant association was present in both distal (adjusted
HR 0.90, 95 % CI 0.85 to 0.96) and proximal hypospadias (HR 0.59, 95 % CI 0.42 to 0.81). Point
estimates remained similar, however non-significant, in sibling comparison. Further, men with either
distal or proximal hypospadias demonstrated an increased probability of conceiving through ART,
regardless of concomitant cryptorchidism. Men with proximal hypospadias were at increased risk of
having a registered diagnosis of male infertility.
CONCLUSIONS
The results of this study suggest that fertility in men with both distal and proximal hypospadias is
impaired, and the analysis in brothers implies that this is not due to shared familial factors.
11:51–11:57
Discussion