Preliminary Results of a Prospective Study of Testicular Sperm Extraction in Young Versus Adult Patients With Nonmosaic 47,XXY Klinefelter Syndrome

• Published in: The journal of clinical endocrinology and metabolism Vol. 100; no. 3; pp. 961 - 967
• Main Authors: Plotton, Ingrid, d'Estaing, Sandrine Giscard, Cuzin, Beatrice, Brosse, Aurélie, Benchaib, Medhi, Lornage, Jacqueline, Ecochard, René, Dijoud, Frederique, Lejeune, Hervé, FERTIPRESERVE group
• Format: Journal Article
• Language: English
• Published: United States Endocrine Society 01-03-2015; Copyright by The Endocrine Society
• Subjects: Adolescent; Adult; Age Factors; Cryopreservation; Embryo Transfer; Female; Fertility Preservation - methods; Humans; Infertility, Male - therapy; Klinefelter Syndrome - pathology; Klinefelter Syndrome - therapy; Life Sciences; Male; Pilot Projects; Pregnancy; Semen Analysis; Semen Preservation; Sperm Injections, Intracytoplasmic; Sperm Retrieval; Young Adult
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2014-3083

Context:
Testicular sperm extraction (TESE) in adult patients with nonmosaic 47,XXY provides a sperm retrieval rate (SRR) of approximately 50%. Age is the only significant prognostic factor. Whether TESE should be performed in adolescent patients for sperm cryopreservation remains to be determined.
Objective:
The objective of the study was to compare SRR between young (15–23 y) and adult (> 23 y) patients with 47,XXY, and to determine whether previous androgenic treatment had a deleterious effect.
Design:
We designed a prospective comparative study between two groups enrolled in parallel from September 2010 onward.
Setting:
University hospital.
Patients:
Forty one patients with nonmosaic 47,XXY karyotype and azoospermia were included. Twenty five patients from 15–22 years of age were assigned to the “Young” group, and 16 patients age 23 years or more, to the “Adult” group.
Intervention:
A bilateral testicular open biopsy was performed by a single surgeon. The reproductive biologist who performed TESE was blind to the patient's age.
Principal Outcome Measure:
The main outcome measure was the SRR. The TESE procedure was considered positive if at least 20 sperm cells could be cryopreserved for intracytoplasmic sperm injection.
Results:
SRR was 13/25 = 52% in the Young group and 10/16 = 62.5% in the Adult group, the difference being nonsignificant (P = .73). Ages were 24.3 ± 7.4 years in the 23 cases of positive TESE, and 23.7 ± 7.4 in the 18 cases of negative TESE, the difference being nonsignificant (P = .42). SRR was 9/17 = 52.9% for patients with and 14/24 = 59.1% for patients without previous testosterone (T) treatment, the difference being nonsignificant (P = .98).
Conclusions:
According to the present results, performing TESE at a younger age (15–23 y) in patients with azoospermic nonmosaic 47,XXY Klinefelter did not increase SRR relative to adult patients (25–39 y). Previous replacement treatment with moderate doses of T did not seem to be deleterious for the recovery of sperm cells by TESE.