MP31-08 EXOGENOUS TESTOSTERONE THERAPY IN MEN WITH KLINEFELTER SYNDROME NEGATIVELY IMPACTS SPERM RETRIEVAL

Abstract

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-08 EXOGENOUS TESTOSTERONE THERAPY IN MEN WITH KLINEFELTER SYNDROME NEGATIVELY IMPACTS SPERM RETRIEVAL Caroline Kang, Nahid Punjani, and Peter N. Schlegel Caroline KangCaroline Kang More articles by this author , Nahid PunjaniNahid Punjani More articles by this author , and Peter N. SchlegelPeter N. Schlegel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Men with Klinefelter syndrome (KS) classically have testicular failure and are at risk for both testosterone (T) deficiency and infertility. T replacement therapy (TRT) often is initiated in adolescence for its potential neurodevelopmental benefits. Unfortunately, exogenous T has a defined adverse effect on spermatogenesis. We sought to examine the effect of exogenous T on sperm retrieval in men with KS. METHODS: All men with KS undergoing sperm retrieval by microdissection testicular sperm extraction (mTESE) performed by a single surgeon between 1995-2020 were reviewed. Demographic data and hormone-modifying agents, such as human chorionic gonadotropin (hCG) and aromatase inhibitors (AI), administered prior to mTESE were obtained. History or current use of exogenous T was recorded and categorized based on formulation into either short- (gel or foam) or long-acting (pellets or injection) groups. Descriptive statistics and SRR are reported. Patients with incomplete data on hormone therapy as well as repeat procedures on the same patient were excluded. RESULTS: A total of 290 sperm retrievals were performed on KS men during the study period. Fourteen men had a history of exogenous TRT or were currently using T at time of mTESE (Table 1). Median age was 34 years (interquartile range (IQR) 31–36), and median testis size was 1.3 mL (IQR 1.0–1.5). Five men had a remote history of TRT up to 2 years prior to mTESE, and received hCG and AI hormone therapy prior to retrieval. Of these, all five (100%) had successful sperm retrieval. In five men receiving topical testosterone and concurrent AI and/or hCG at time of mTESE, only two (40%) had successful sperm retrieval. No men receiving continuous delivery of exogenous testosterone (e.g., injectable or pellet) with concurrent hCG had sperm identified during mTESE. CONCLUSIONS: Exogenous TRT is common in KS patients. Long-acting (e.g. injectable or implantable T) therapy suppresses gonadotropin production and sperm production, predisposing men to failed sperm retrieval. However, T monotherapy with short-acting (e.g. topical) formulations together with AIs can maintain endogenous gonadotropin production and spermatogenesis; such therapy is consistent with sperm retrieval in KS men. Additional prospective trials are needed to elucidate the effects of T on sperm retrieval in KS patients. Source of Funding: CK and NP are supported in part by the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e557-e558 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Caroline Kang More articles by this author Nahid Punjani More articles by this author Peter N. Schlegel More articles by this author Expand All Advertisement Loading ...