All men have doubts: Will a small thing affect fertility?

In clinical practice, we often encounter cases where some adult men have testicles that are smaller than normal, and they are worried that it may affect their fertility. In fact, small testicles also have physiological and pathological differences. Physiologically small testicles generally do not affect fertility as long as sufficient normal sperm can be produced.

There are many reasons for pathological testicular shrinkage, the most common of which are chronic wasting diseases, endocrine disorders (hypothyroidism, hypopituitarism), persistent high fever, taking large amounts of female hormones, viral orchitis (such as mumps complicated with orchitis), testicular syphilis, etc. All of these conditions can cause the testicles to shrink, becoming smaller than normal.

Pathological testicular atrophy and reduction in size is usually due to the involvement of spermatogonia or spermatocytes in the seminiferous tubules. When these cells atrophy and cannot grow sperm, or are damaged and cannot produce normal sperm, the testicles atrophy and decrease in size.

In addition, it is often accompanied by infertility; however, because the interstitial cells that secrete male hormones are less affected, it generally does not affect the development of male reproductive organs and male secondary characteristics (such as beard growth, lower voice, prominent Adam's apple, muscular development, etc.). From the actual clinical situation, it is rare for people to suffer from severe testicular atrophy and thus infertility.

Whether testicular atrophy is accompanied by fertility dysfunction can be determined by a semen microscopy examination. If the sperm count per milliliter of semen is less than 20 to 60 million, and their motility is reduced and their morphology is abnormal, infertility should be considered.