Bringing home a new baby can feel like you’re running before you even learn to walk. You’re figuring out feeding times, sleep routines and diaper changes, all while your baby seems to grow at lightning speed.
During this time, your health care provider also checks for important health milestones, including the position of your baby boy’s testicles. If one or both testicles haven’t descended (dropped down) at birth, it’s a common condition called cryptorchidism (undescended testicles).
Most of the time, undescended testicles are not an emergency. Many cases fix themselves in the first few months of life. But it’s good to know what this diagnosis means, what is normal, what is not and when treatment might be needed.
We spoke with Ariella Friedman, MD, a pediatric urologist with Banner Children’s who regularly cares for infants and children with this condition to learn more.
First things first: Should I worry?
For most parents, the short answer is no, at least not right away.
“About two-thirds of the time, a testicle that hasn't moved down by birth will do so on its own,” Dr. Friedman said. “Usually, this happens during a short hormone increase called ‘mini-puberty’ when a baby is about one to four months old. This hormone boost often helps the testicle move into the scrotum.”
That’s why health care providers closely monitor the situation, rather than rush into treatment during the first months of life.
What are undescended testicles?
Undescended testicles happen when one or both testicles don’t move down into the scrotum before birth.
Normally, testicles form in the belly during pregnancy and move down into the scrotum around 33 weeks of gestation. If that process doesn’t finish, the testicle may remain higher.
How common is this?
- About 3% of full-term baby boys are born with an undescended testicle
- About 30% of premature baby boys are affected
If your baby was born early, this diagnosis is especially common and often temporary.
When do testicles usually descend on their own?
Most spontaneous descent happens early, between birth and 4 months.
“If the testicle hasn’t come down by 6 months of age, the chance of it doing so naturally drops to less than 10%,” Dr. Friedman said. “At that point, surgery is usually recommended within the next six months.”
Why do some testicles not descend at birth?
Testicles may not descend for several reasons, including:
- Premature birth: Babies born early may not have time for their testicles to move down before birth.
- Hormone levels: Low levels of certain hormones can slow the process.
- Narrow or blocked passage: The pathway for the testicles to move down may be too tight.
- Family history: Genetics can affect how the testicles develop.
What’s the difference between a retractile testicle and an undescended testicle?
A retractile testicle can move up into the body and back down into the scrotum. This happens because of a strong muscle reflex.
Common triggers include:
- Cold temperatures
- Fear or stress
- Crying or being upset
“At rest, a retractile testicle sits in the scrotum,” Dr. Friedman said. “You may notice it during a warm bath, when your child is relaxed or sitting with legs apart.”
A truly undescended testicle:
- Does not stay in the scrotum
- Springs back up even when gently pulled down
- Never fully settled into the scrotum
Retractile testicles don't need surgery but you should get a check-up every year. About one in four can become ascended (stay up in the body) over time.
Why does treatment matter?
Even though your baby may seem comfortable now, testicles need the cooler environment of the scrotum to develop normally.
When a testicle remains higher, several things can happen.
Fertility issues
“Changes in sperm development can begin very early, sometimes before one or two years of age,” Dr. Friedman said.
- Boys with one undescended testicle usually have fertility rates similar to the general population
- Boys with two undescended testicles may have lower fertility rates, even after surgery
Early surgery helps improve how the testicle develops and functions but it might not be exactly the same as a testicle that was in the right spot from the start.
Cancer risk
Boys with a history of undescended testicles have a higher risk of testicular cancer later in life.
“That risk is highest when the testicle stays elevated,” Dr. Friedman said. “Surgery lowers the risk, though it doesn’t bring it down to zero.”
Early correction also makes future self-exams and monitoring easier.
Other risks
An untreated undescended testicle can also be associated with:
- Testicular shrinkage (atrophy)
- Injury, since it can be pressed against the pubic bone
- Testicular torsion, where blood supply twists
- Inguinal hernia, which can often be repaired during the same surgery
What does treatment involve?
If surgery is needed, the procedure is called an orchiopexy. The surgery is scheduled with a pediatric urologist after your child reaches 6 months of age to ensure the safe use of anesthesia. The success rate for an orchiopexy is 98%.
What happens during surgery?
- Your child is fully asleep under anesthesia
- Surgery takes about 30 to 60 minutes
- One or two small incisions are made, depending on testicle location
- A numbing medicine is given to reduce pain after the procedure
“The goal is to move the testicle into the scrotum and secure it there,” Dr. Friedman said. “Most infants recover quickly with minimal discomfort.”
After surgery, dressings or stitches may fall off or dissolve on their own. Do not bathe for two days and avoid bouncers and straddle activities for two weeks.
What if the testicle can’t be felt?
If you can't feel the testicle, a laparoscopic orchiopexy might be suggested to look for it inside the belly.
“There are typically two outcomes from laparoscopic exploratory surgery,” Dr. Friedman said. “Either the testicle is found within the belly and surgically brought down, or the testicle atrophied in utero. In the latter case, the remaining tissue is usually removed.”
A laparoscopic orchiopexy involves:
- One to three tiny belly incisions
- A longer surgery (one to two hours)
- Occasionally, more than one surgery
About 85% of laparoscopic cases are successful.
Cryptorchidism in older children
For older children and teenagers with undescended testicles, it can be harder to fix the problem if it was not treated when they were infants. For some adults, it is safer to remove the testicle completely rather than just try to put it back in the scrotum.
“All this is said to emphasize that early treatment is encouraged, not to discourage later treatment,” Dr. Friedman said. “Regardless of age, cryptorchidism should be treated the right way to minimize long-term complications.”
Bottom line
If your baby boy has an undescended testicle, regular checkups are important. Most testicles drop within the first few months. If they haven’t by 6 months old, surgery is usually recommended to protect fertility, reduce cancer risk and prevent other complications. Annual exams remain important after treatment to ensure ongoing health.
If concerns come up, speak with your provider or a pediatric specialist at Banner Children’s who is experienced in caring for infants and guiding families through every step.
