Does orchidopexy for testicular torsion affect long-term fertility parameters in males: A systematic review

The aim of this study is to investigate long-term fertility outcomes following orchidopexy performed for testicular torsion.

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD420251152057). A literature search was conducted from June 2025 to October 2025 across Scopus, PubMed, Web of Science and the StarPlus Library (University of Sheffield). Studies reporting on male patients with a history of testicular torsion who underwent orchidopexy were included. Eligible study designs comprised case reports/series, cohort studies, case-control studies and randomised controlled trials. Studies involving cryptorchidism, orchidectomy or no intervention following exploration, as well as systematic reviews, meta-analyses, editorials, book chapters, conference proceedings/posters, reviews and commentaries, were excluded.

Seventeen articles with 324 patients analysed fertility and hormonal outcomes following detorsion with orchidopexy. Primary outcomes were classified as fertility parameters and semen analysis. Reported pregnancy rates were high, ranging from 90.2% to 91.3% with reported time to pregnancy of 6.6 to 8.9 months. Six studies reported semen parameters with sperm count (11.2-235.4 × 10), motility (51.6-67%) and morphology (3.6-28%) generally within reported reference ranges, although substantial variability existed between studies. Secondary outcomes included hormonal analysis and anti-sperm antibody prevalence. Five studies reported hormonal follicle-stimulating hormone (FSH) and luteinising hormone (LH) levels, eight studies reported testosterone levels and two reported inhibin B levels. Anti-sperm antibodies (ASA) were described in two studies, with positive ASA ranging from 20% to 27.2%. The reported follow-up duration across nine studies was 0.12-11.8 years, although none reported fertility outcomes longitudinally.

This review suggests that fertility potential is generally preserved following testicular detorsion with orchidopexy, with the majority of studies reporting favourable semen profiles and pregnancy outcomes. However, the small number of heterogeneous studies and limited long-term data highlight the need for larger, standardised studies to better define the long-term impact of testicular torsion on fertility.