Hypospadias: A Congenital Abnormality That Causes Male Factor Infertility


What is Hypospadias?

Hypospadias is a birth defect that affects the male penis. It can present in several ways:

  • The opening of the urethra (the tube that urine travels through from the bladder to outside of the body), which is normally found on the tip of the penis, is located instead on its underside, anywhere along the shaft of the penis to the scrotum
  • Incompletely developed foreskin.
  • A bend or slight curve in the penis, even when it is fully erect.

Hypospadias can negatively impact male infertility in several ways:

  • Since the urethra carries semen out of the body, the altered location of the opening can result in difficulties with ejaculation.
  • Curvatures of the penis may make sexual intercourse difficult or painful.
  • Males with hypospadias are also more likely to be born with an undescended testicle, which can also decrease sperm count.

What are the Rates of Hypospadias?

Hypospadias occurs rarely. It is present in around one out of every 250 live male births.

What are the Causes of Hypospadias?

The exact cause of hypospadias is not yet known, but here are a few theories:

Researchers believe that there may be a genetic component to hypospadias, since studies have shown that it is more common in twins, and among male family members.

Another theory is that hypospadias may be influenced by hormones.

Other studies have found a higher association of hypospadias with fertility treatment, which is thought to be due to increased exposure to hormones like progesterone and estrogen.

How is Hypospadias Diagnosed?

Hypospadias is usually diagnosed when the male is a newborn, through a physical examination by the baby’s doctor. If hypospadias is suspected, the doctor may order an X-ray test that provides pictures of the urinary tract, as well as the kidneys and bladder.

How is Hypospadias Treated?

Hypospadias is usually treated by surgery within the first year of life. Hypospadias surgery can include:

  • Repositioning the urethra.
  • Placing the urethra opening at the head of the penis.
  • Reconstructing the skin around the opening.
  • The surgeon will reroute the urethra opening to the head of the penis.

Hypospadias surgery can also be done as an adult, though it is best done in infants and young children. Some surgeries are easier than others, depending on the location of the urethral opening. Complications are more likely in adults, and can include:

  • Bleeding.
  • Infection.
  • Narrowing of the urethra.
  • Curvature of the penis.

How Does Hypospadias Impact Pregnancy?

Fertility problems should no longer remain after the hypospadias is surgically corrected. After surgery, the curve of the penis should be straightened, and proper forward ejaculation should be achieved.

Dr. Sydney Chang is a Fellow in Reproductive Endocrinology and Infertility at the Icahn School of Medicine at Mount Sinai/Reproductive Medicine Associates of New York.  She earned her Bachelor of Arts in Human Biology at Stanford University, where she graduated with Honors and Distinction. She went on to complete her medical school education at Duke University School of Medicine. She completed her residency in Obstetrics, Gynecology, and Women’s Health at the Albert Einstein College of Medicine, where she served as an administrative chief resident.