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Sperm retrieval in men with nonmosaic Klinefelter's syndrome can be successful with microdissection testicular sperm extraction.
The researchers looked for factors that could predict successful sperm retrieval and found it was testosterone level, not the type of drug treatment, that made a difference. The researchers started therapy with aromatase inhibitors, based on senior author Peter Schlegel, MD's research supporting their success (J Urol 2002; 167:624-9). If the men's testosterone levels did not respond to aromatase inhibitor therapy, human chorionic gonadotropin or clomiphene citrate (Clomid) was added to the regimen.
Overall, of 68 patients with Klinefelter's syndrome who underwent 91 mTESE attempts, the technique achieved a 68% sperm retrieval rate, a 53% clinical pregnancy rate, and a 45% live birth rate, reported first author Ranjith Ramasamy, MD, a urology resident at New York-Presbyterian/Weill Cornell. The men with normal baseline testosterone levels (≥300 ng/dL) had the best sperm retrieval rates (86%). For those with abnormal hormone levels, when medical therapy was able to bring testosterone levels up to 250 ng/dL, the sperm retrieval rate was 77%, but for men whose treatment failed to bring testosterone levels to that level, the retrieval rate was only 55%.
The researchers also looked at the effect of age, testicular volume, LH and FSH levels, and the type of medical therapy on sperm retrieval and fertility rates. They found the only other factor that approached having a statistically significant effect was age. The mean age overall was 33 years, and it was 32 years in the 62 men for whom sperm retrieval was successful, whereas it was 35 years in the men for whom the sperm retrieval procedure resulted in failure.
"This is the first time that we showed that men who respond to the medical therapy with a final testosterone level of 250 ng/dL or higher are the ones for whom microdissection TESE has the best chance of success," Dr. Ramasamy told Urology Times. "It gives the patients some kind of information on what to expect in terms of sperm retrieval. So, if they respond to therapy with a higher testosterone level, their chances of sperm retrieval are higher."
Data were presented at the 2009 AUA annual meeting and subsequently published in the Journal of Urology (2009; 182:1108-13).