Age-Related and Individual Anatomical Variation in Testicular Topography in Human Fetuses

Abstract

At present, male infertility remains an urgent medical concern. From year to year, despite advances in methods of diagnosis and treatment, medicine encounters an increasing number of infertile couples with male infertility playing a leading role. Prerequisites for fertility disorders very frequently appear in childhood. Urologists consider cryptorchidism a leading cause of male infertility. The aim of our study was to establish the relationship between testicular descent to the scrotum and the age of the fetus. Material and methods. The study was conducted using 195 specimens of male fetuses aged 4–10 months with 81.0–375.0 mm parietalcoccygeal length (PCL) using the methods of macromicroscopic, conventional, and microslide preparation under control of binocular loupes and morphometry. Results. At the beginning of the fetal period of human ontogenesis (fetuses 81.0–135.0 mm PCL), the right and left testicles are mainly located above the corresponding deep inguinal ring and they are less often located in a region of the iliac fossae. An analysis of topographic and anatomical features of the male reproductive glands in 5-month-old fetuses (136.0–185.0 mm PCL) revealed that the testicles were located within the large pelvis, with the lower end of both the right and left testicles located above the entrance to the deep inguinal ring at a distance that equals the length of the pelvic part of the gubernaculum testis—3.2 ± 0.3 mm (right) and 2.8 ± 0.2 mm (left). In 11 fetuses aged 7 months (231.0–270.0 mm PCL), the lower ends of the testicles and their gubernaculum testis are immersed in the corresponding deep inguinal ring. In eight fetuses, the testicles were within the deep inguinal ring. A combination of many factors contributes to the final migration of a testicle through the inguinal canal into the scrotum (fetuses: 270.0 cm–290.0 mm PCL), including muscle contraction of the anterolateral abdominal wall, an increase in intra-abdominal pressure, contractile capacity of the gubernaculum testis of the testicle, the vaginal process of the peritoneum, and the neuro-muscular system. We believe that the gubernaculum testis is a particularly significant factor in testicular descent to the scrotum. The gubernaculum testis is maximally developed prior to migration of a testicle through the inguinal canal (eighth month of antenatal development), as evidenced by the prevalence of smooth muscle cells over connective tissue elements. An analysis of testicular topography in fetuses aged 9 months (311.0–345.0 mm PCL) revealed that testicles were located in the scrotum in nine fetuses, near the superficial inguinal ring in six fetuses, within the inguinal canal in four cases, and in the deep inguinal ring in one case. In fetuses aged 10 months (346.0–375.0 mm PCL), testicles were located in the scrotum in 13 cases and within the inguinal canal in seven cases. According to our research, the fusion of layers of the vaginal process of the peritoneum occurs in fetuses aged 9–10 months, resulting in the disappearance of the communication of its cavity with the peritoneum. A delay in the fusion of the peritoneal vaginal process layers at the end of the fetal period is an anatomic prerequisite for the occurrence of congenital inguinal-scrotal hernias. Conclusions. It has been found that the rate of testicular descent to the scrotum does not always coincide with the corresponding stage of fetal development. An accelerated development of the gubernaculum testis in fetuses aged 5–8 months is a major factor of heterochronic development of a testicle and subsequent testicular descent into the scrotum.