(087) PEDIATRIC BILATERAL INGUINAL HERNIA REPAIR IMPACTS FUTURE FERTILITY

Abstract Introduction Inguinal hernia repair and orchiopexy are common to both pediatric Urologist and Surgeons. Unilateral intervention would be expected to have limited impact on fertility given contralateral testis has been unaffected, which has been confirmed in the literature. Given this, a decrease in fertility would be expected for bilateral intervention. In adults, bilateral hernia repairs have limited impact on fertility; however, there is limited data to suggest the same in pediatric patients. Given the paucity of pediatric literature on the implications of bilateral inguinal surgery on future fertility and sperm parameters, providers are currently unable to adequately counsel parents about the risks this surgery may carry to fecundity. Objective We aimed to assess the impact of B/L IHR on male fertility and paternity, hypothesizing significant implications. Methods We conducted a case–control study utilizing a statewide database, which encompasses demographic, medical, and residential data for over 90% of the state's pediatric population. Cases, matched 1:1, comprised males who had B/L IHR and males who underwent pediatric BO before age 18 from 1996-2022. Controls were those without a history of pediatric B/L IHR or BO (matched 3:1). Multivariate Cox proportional hazards models assessed the association between BO or B/L IHR and infertility and paternity. For models, patients were followed from either age 18, first residence in Utah, or 1996 (study initiation), until receiving an infertility diagnosis or until appearing as a father on a birth certificate. An infertility diagnoses, unidentified partners, or children prior to 18/residence in Utah/1996, were excluded. Results 1156 B/L IHR and 494 BO cases with 5780 non-surgical controls were included. The cohort was predominantly white (87.8%) and non-Hispanic (68.4%). 20.5% having at least one child. Multivariate Cox regression showed higher likelihoods of infertility 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 B/L IHR and orchiopexy elevate infertility rates compared to controls, with orchiopexy suggesting a potential trend towards reduced paternity. The risk of male-factor infertility post-pediatric B/L IHR is notably higher, akin to that of patients undergoing bilateral orchiopexy. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: StreamDx, Inherent Bioscience, Turtle Health, Maimus, Carrot Fertility.