Hypospadias & Male Fertility

Q. My husband had many surgeries as a child for his hypospadias. We have been trying for a year to get pregnant. I have been checked out and I am OK. Today, the doctors say that hypospadias is not a problem. But 28 years ago, it was really different. Can he still have kids? I don’t know if they still do the same surgery today or not.

A. Hypospadias is a condition where the urethral meatus (opening) is not on the tip of the penile glans; instead, the opening occurs on the ventral side (bottom or underside) of the penis. We don’t really understand why this malformation occurs. It may result from lower levels of male hormones at the time the genitals are formed, while the baby is still in the womb. During pregnancy with a male fetus, the hormone hCG from the mother’s placenta will actually stimulate the fetus’ testicles to make testosterone, which in turn prompts the formation of the male external genitalia. The testosterone is converted to the more potent DHT before it carries out these actions. A problem may occur at any point in this process, so the culprit may be abnormal placental hCG production, low testosterone production from the testicle, or incomplete conversion to DHT.