Microdissection testicular sperm extraction for non-mosaic klinefelter syndrome patients

Abstract

OBJECTIVE: Fertilization and pregnancies can be obtained with spermatozoa recovered not only from the ejaculate, but seminiferous tubules (testicular sperm extraction, TESE). Microdissection (Micro)TESE, in combination with intracytoplasmic sperm injection (ICSI), presently is used to treat infertility in cases of NOA including Klinefelter syndrome (KS). KS is the most common sex-chromosome disorder among infertile males, with a prevalence of 1 in 660 men and is a frequent cause of hypogonadism and infertility. The aim of this study is to assess the prevalence and the significance including sperm retrieval rate (SRR) by micro-TESE in non-obstructive azoospermic patients including KS. DESIGN: Retrospective clinical analysis. MATERIALSANDMETHODS: The records were retrospectively evaluated for 1028 NOA patients (including 123 non-mosaic KS patients) who were underwent micro-TESE. Chromosomal analysis was performed on all patients on cultured lymphocytes from peripheral blood. Micro-TESE was used in which seminiferous tubule are directly examined throughout the testicle using an operating microscope and selectively biopsied for all of the NOA patients in modified Schlegel’s method. We did not undergo preoperative hormonal therapy for KS patients. In our study, KS patients did not have microdeletion of Y chromosomes. RESULTS: Testicular sperm were successfully retrieved by microTESE in 69 of 123 (56.1%) non-mosaic KS and 380 of 905 (42.0%) not KS NOA patients. Of these, 48 (69.6%) KS and 344 (90.5%) not KS NOA patinets had sperm identified through the initial wide incision alone. For patients with KS, the chance of sperm retrieval on the contralateral side after a negative unilateral microdissection was 28.0% (21/75) and significant higher than not KS NOA patients (36/5611⁄46.4%) (p <0.001). In almost all patients in whom micro-TESE was successful we could identify focal spermatogenesis in dilated and opaque seminiferous tubules surrounded by shrunken tubules or fibrous tissue. No correlation was found between serum FSH, LH, and T level with the success of sperm retrieval. Testicular volume also did not affect the SRR for micro-TESE. Patient age in successful micro-TESE for cases of KS is significantly younger (33.5 4.2 years) than that in failed cases (37.4 3.9 years) (p <0.05). CONCLUSION: Micro-TESE is particularly helpful for successful sperm retrieval in KS cases. In NOA, the absence of uniformity in testicular tissue is a critical key to succeed and rationale in microTESE.