Probability of taking home baby in cases of non-mosaic Klinefelter's syndrome based on the experience of 60 patients

Abstract

OBJECTIVE: In this study, we aimed to assess the efficacy of testicular sperm extraction (TESE) combined with ICSI as a therapeutic option for azoospermic Klinefelter's syndrome (KS) patients. DESIGN: Retrospective analysis of clinical outcome in 60 KS patients. MATERIALS AND METHODS: A total of 60 azoospermic non-mosaic KS patients visited the clinic from 1999 to 2008 was involved in the study. On all the patients with written informed consent, TESE was attempted. Multiple testicular biopsy method was utilized until the end of 2004 (26 cases) while micro-dissection TESE was exploited (34 cases) thereafter. When at least one viable spermatozoon was obtained, ICSI was performed with fresh, frozen-thawed or re-frozen re-thawed testicular spermatozoa. RESULTS: The rate of successful sperm retrieval was 45.0% (27/60). With multiple testicular biopsy method the sperm recovery rate was 34.6% (9/26) while it was 52.9% (18/34) with micro-dissection technique. Among 27 patients with viable spermatozoa, 24 cases underwent total of 35 ICSI treatment cycles, 7 with fresh, 27 with frozen-thawed, and 1 with re-frozen re-thawed testicular spermatozoa. In 2 cases no embryos were available for transfer. Consequently 30 fresh and 9 frozen-thawed embryo transfers were performed, resulting with 19 clinical pregnancies and 15 live births so far. Overall 22 newborn (11 boys and 11 girls) were obtained following TESE-ICSI, with 1 case being still ongoing at the moment of the preparation of this abstract. CONCLUSIONS: Although statistically not significant (P = 0.064), there was a trend of higher sperm recovery rate in micro-dissection TESE than conventional method. This study with a relatively large number of cases, demonstrates that TESE-ICSI is an effective treatment option for non-mosaic KS patients with thorough genetic counseling. It can be estimated that about a half of cases sperm can be retrieved with over 60% of live birth rate, thereby, approximately 30% of take home baby rate is expected in first seen azoospermic KS patients.