Newborn Cryptorchidism: When Testicles Don’t Descend

Emotions are high when a baby enters the world, and parents want the best for their newborn. When an anomaly pops up, it's easy to worry - even when it's something benign.

One of the most common findings during newborn exams is an undescended testicle, also called cryptorchidism. This condition can sound alarming, but most cases are manageable and often resolve on their own within the first six months. It becomes uncommon for the testicle to descend spontaneously after that point, and even when the testicle remains undescended up to the first year, it can be easily treated with a simple surgery. However, there are reasons for addressing it as soon as possible.

In addition to the immediate concern, parents often wonder what this means for their child's overall health, future fertility, and even whether a newborn circumcision should be delayed.
Asking questions, regardless of how off-the-wall they may seem, reflects your awareness and care. The answers you receive can ease uncertainty and prepare you for the support your baby needs in those first few weeks and months.

What Are Undescended Testicles?

Undescended testicles occur when one or both of a baby's testicles haven't moved down into the scrotum by the time of birth. Normally, the testicles develop inside the abdomen of the fetus and gradually descend into the scrotum in the last few months of pregnancy. This descent is important because the scrotum provides a cooler environment that's essential for healthy testicular development and function.

Cryptorchidism is relatively common, affecting about three percent of full-term newborn boys and up to 30 percent of premature infants.¹ Because the testicles aren't in their usual position, parents may notice a smaller or asymmetrical scrotum, or the pediatrician may notice that a testicle can't be felt during a physical exam.

It's typical for pediatricians to check for this condition during newborn exams and follow up as needed. In many cases, the testicles will descend on their own within the first few months after birth. If they don't, doctors may recommend monitoring for a short period of time, and eventually treatment to reduce complications later in childhood or adulthood that can affect fertility or increase the chances of other health concerns.

Will This Affect My Baby's Health or Fertility?

The good news is that for the majority of boys, the condition is temporary, and most testes that are undescended at birth will descend spontaneously, so those children can then grow and develop normally.

The main reason doctors monitor and, when needed, treat undescended testicles is to protect future fertility and lower certain risks later in life. Testicles that remain outside of the scrotum for too long are exposed to slightly higher body temperatures, which, over time, affects the cells responsible for producing sperm.

Most boys treated for cryptorchidism go on to live healthy lives with normal fertility. Regular follow-up with your pediatrician and urologist ensures that your child's development is on track and that any concerns are addressed early.

Another point parents may hear about is an increased risk of testicular cancer. While the risk is higher than in boys whose testicles descend naturally, it's important to keep perspective: the overall likelihood is still very low, and early treatment further reduces the risk. Bringing the testicle into the scrotum through surgery makes it much easier to examine and monitor in the future.

Undescended testicles are something to pay attention to, but not to panic over. Early correction (once it's determined that the testes are not descending on their own, typically around 6 months and definitely before 18 months old) significantly reduces associated health concerns - the closer corrective surgery is performed to 6 months of age, the better the chances that sperm-producing cells will remain as healthy as possible and function normally into adulthood.

Should Circumcision Be Delayed?

In most cases, an undescended testis has no impact on performing a circumcision.
Parents often wonder about the best time to schedule circumcision for their infant, especially if other medical factors are in play, but pediatric urologists generally agree that this condition alone is not a reason to delay circumcision. In most cases, circumcision can safely be performed even when testicular descent has not yet occurred.

That said, there are rare circumstances where waiting makes sense. For example, if a baby has other health concerns, was born prematurely, or if there are anatomical considerations that a pediatrician or urologist wants to evaluate further, the procedure may be postponed until the child is a bit older. Parents may also choose to wait for personal, cultural, or religious reasons.

However, it's important not to wait too long without guidance. Circumcision is easier to perform, and recovery is smoother in the newborn period or early infancy. As children grow, the procedure can become more involved, sometimes requiring general anesthesia instead of a quick in-office procedure.
The decision is best made in consultation with a pediatric urologist, who can help weigh individual circumstances and provide recommendations tailored to your baby's health and your family's preferences.

What Happens If Treatment Is Needed?

If a testicle remains undescended after a few months, your baby's doctor may recommend a procedure called orchiopexy. This is a routine urologic surgery used to move the testicle into the scrotum and secure it in place. The recommended timing for orchiopexy is usually as soon after six months old as possible. Early correction not only helps preserve future fertility and reduce the risk of testicular cancer, but it also makes the surgery technically easier. At this age, the baby is still small, and the distance between his physiological structures is shorter, which can simplify the procedure.

The surgery is typically performed on an outpatient basis under general anesthesia, with most babies recovering quickly and going home the same day. Pediatric urologists are the experts in this area and the only specialist surgeons who should perform the procedure.

In some cases, both circumcision and orchiopexy can be done during the same surgical session. This can reduce the need for two separate rounds of anesthesia and streamline the recovery process. Your care team will guide you through whether combining procedures is appropriate for your baby, based on their overall health and anatomy.

Try Not to Worry

Hearing that your baby boy has undescended testicles can be surprising and cause any parent to be concerned. But take heart: cryptorchidism is a common and very treatable condition, and the outlook is overwhelmingly positive when it's managed early and thoughtfully by a specialist in pediatric urology. It's also possible for the testes to descend naturally within the first six months after delivery. Try to spend your time snuggling rather than worrying.

Many families have walked the same road, faced the same questions, and come through with healthy outcomes. The most important thing you can do (besides enjoying your baby to the fullest!) is to stay informed and surround yourself with experienced medical professionals who prioritize your baby's safety and long-term well-being.

At Georgia Urology, we work with families across a wide range of situations. We're happy to collaborate with your pediatrician and help you create a plan that fits your child's unique needs.
If you have any questions or concerns, reach out to speak with one of our providers or schedule a consultation.

Reference:

1. Leslie, S. W., Sajjad, H., & Villanueva, C. A. (2024, May 5). Cryptorchidism. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470270/.