Factors For Successful Sperm Retrieval Research Articles

Microsurgical Testicular Sperm Extraction: Predictive Factors and Outcomes for Men with Nonobstructive Azoospermia

Background. Nonobstructive azoospermia (NOA) is a frequent cause of male infertility, and microsurgical testicular sperm extraction (micro-TESE) is an effective technique for sperm retrieval in NOA cases. However, the predictive factors for successful sperm retrieval and the outcomes of micro-TESE in NOA patients are not fully understood. Methods. In this retrospective study, we evaluated the predictive value of preoperative data and outcomes of micro-TESE in 172 men with NOA who underwent the procedure between April 2012 and February 2021. Patients’ age, medical history, testicular size, hormonal profile, testicular histology, and sperm retrieval were recorded. Results. 172 cases of micro-TESE were performed (99 unilateral and 73 bilateral) and testicular sperm retrieval rate (SRR) was 72.7%. There was no statistical difference in age, testicular size, and hormonal profiles between positive SRR and negative SRR groups. Clinical varicocele and previous orchitis did not significantly affect the result of micro-TESE. Y chromosome microdeletions were detected in seven patients. On histological examination, hypospermatogenesis was found in 39% of patients who underwent testicular biopsy. SRR was higher in patients with hypospermatogenesis than in other groups. Conclusions. Testicular microdissection is an effective and safe procedure for nonobstructive azoospermia patients, regardless of the different etiologies and preoperative data. Age, testicular size, and hormonal levels did not predict the success of micro-TESE. The presence of hypospermatogenesis was associated with a higher SRR. Clinical varicocele and previous orchitis were not significantly associated with the outcome of micro-TESE.

The Klinefelter Syndrome and Testicular Sperm Retrieval Outcomes

Klinefelter syndrome (KS), caused by the presence of an extra X chromosome, is the most prevalent chromosomal sexual anomaly, with an estimated incidence of 1:500/1000 per male live birth (karyotype 47,XXY). High stature, tiny testicles, small penis, gynecomastia, feminine body proportions and hair, visceral obesity, and testicular failure are all symptoms of KS. Endocrine (osteoporosis, obesity, diabetes), musculoskeletal, cardiovascular, autoimmune disorders, cancer, neurocognitive disabilities, and infertility are also outcomes of KS. Causal theories are discussed in addition to hormonal characteristics and testicular histology. The retrieval of spermatozoa from the testicles for subsequent use in assisted reproduction treatments is discussed in the final sections. Despite testicular atrophy, reproductive treatments allow excellent results, with rates of 40-60% of spermatozoa recovery, 60% of clinical pregnancy, and 50% of newborns. This is followed by a review on the predictive factors for successful sperm retrieval. The risks of passing on the genetic defect to children are also discussed. Although the risk is low (0.63%) when compared to the general population (0.5-1%), patients should be informed about embryo selection through pre-implantation genetic testing (avoids clinical termination of pregnancy). Finally, readers are directed to a number of reviews where they can enhance their understanding of comprehensive diagnosis, clinical care, and fertility preservation.

Predictive factors for successful sperm retrieval by microdissection testicular sperm extraction in men with nonobstructive azoospermia and a history of cryptorchidism.

This study aims to explore the factors influencing the success rate of the microdissection testicular sperm extraction (Micro-TESE) in patients with nonobstructive azoospermia (NOA) and cryptorchidism. Clinical data of 162 patients with cryptorchidism who underwent Micro-TESE due to infertility from December 2015 to May 2020 in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively. In the univariate analysis, significant differences in the age of patient at the time of orchidopexy (median [interquartile range, IQR]: 7.0 [4.0–11.0] years vs 11.5 [9.0–14.5] years, P < 0.001), interval between orchidopexy and Micro-TESE (mean ± standard deviation: 17.5 ± 5.0 years vs 14.4 ± 4.4 years, P < 0.001), severity of cryptorchidism (unilateral [62.8%] vs bilateral [31.6%], P < 0.001; location of cryptorchidism, intra-abdominal [27.3%] vs inguinal [44.8%] vs suprascrotal [66.7%], P < 0.001), volume of the dominant testis (median [IQR]: 17.00 [15.00–19.00] ml vs 14.50 [11.75–16.25] ml, P < 0.001), and levels of follicle-stimulating hormone (FSH; P = 0.004) and testosterone (P = 0.006) were observed between the successful and failed sperm extraction groups. After conducting the multivariate analysis, four of these factors, including unilateral/bilateral cryptorchidism (P < 0.001), location of cryptorchidism (P = 0.032), age of orchidopexy (P < 0.001), and dominant testicular volume, were adopted in the clinical prediction model to evaluate preoperatively the success rate of Micro-TESE for patients with NOA and cryptorchidism. The likelihood of successful sperm retrieval by Micro-TESE in men with NOA and cryptorchidism increased in patients with mild forms of cryptorchidism.

Predictive factors of successful testicular sperm extraction for non-obstructive azoospermia with a history of bilateral cryptorchidism and normal testosterone.

This study aimed to assess the predictive factors of successful sperm retrieval in non-obstructive azoospermia with a history of bilateral cryptorchidism. This retrospective study included 103 patients with azoospermia who had micro-dissection testicular sperm extraction between January 2010 and January 2020. The median (range) age of the patients and their wives in the study group was 33 (21-44) and 24 (19-33)years, respectively. The patients with low testosterone level (<3ng/dl) were prescribed with human chorionic gonadotropin 5,000IU injection every 3days for 3months. Those with persistent low testosterone even after hormonal stimulation were excluded. Sperms were retrieved from 64 (62%) patients, whilst failed in 39 (38%) patients. On univariate analysis, the median testicular volume was significantly larger in the successful group versus the failed group (p<.001), serum FSH and serum LH were significantly lower in the successful group (p=.001), serum testosterone was significantly higher in the successful group compared to the failed group (p<.001) and the age of orchidopexy was lower in the successful group versus the failed group (p=.016). On multivariate analysis, the average testicular volume and the serum testosterone levels were independent factors for successful sperm retrieval.

MP21-04 SUCCESSFUL SPERM RETRIEVAL FOR MEN WITH Y CHROMOSOME AZFC MICRODELETION

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP21)1 Sep 2021MP21-04 SUCCESSFUL SPERM RETRIEVAL FOR MEN WITH Y CHROMOSOME AZFC MICRODELETION I-Shen Huang, Wei-Jen Chen, and William J Huang I-Shen HuangI-Shen Huang More articles by this author , Wei-Jen ChenWei-Jen Chen More articles by this author , and William J HuangWilliam J Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002006.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Among the genetic aberrations contributing to male infertility, the deletion of the AZFc region of the Y chromosome is a common cause of spermatogenetic failure and the chances for successful surgical sperm extraction from azoospermic men with AZFc region microdeletion are relatively good. Nevertheless, it is still a challenge to procure sperm from a sizeable proportion of individuals with AZFc microdeletion, even when meticulous surgical measures are employed. The objective of this study is to identify predictive factors for successful sperm retrieval in men with AZFc microdeletion. METHODS: 76 infertile men were studied, each having Y chromosome AZFc microdeletion at some time during a 10-year period, as confirmed by multiplex polymerase chain reaction (PCR) amplification of STS (sequence tagged site). For each patient, the endocrine profile including serum follicle stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), prolactin (PRL) and estradiol (E2) was recorded, along with intratesticular testosterone level (ITT), age and testicular size. The factors were further analyzed to determine the key predictors for successful sperm retrieval. RESULTS: Of the 76 men with AZFc microdeletion, 56 were classified as having non-obstructive azoospermia (NOA), 8 as having cryptozoospermia, and 12 as having severe oligoasthenoteratozoospermia (OAT). Of the 56 men with azoospermia, 50 received microdissection TESE (mTESE), and sperm retrieval was successful in 37 of those cases (74 %). A significantly lower serum FSH (P = 0.02) was found in those patients from whom sperm could be successfully retrieved. On the other hand, parameters such as levels of LH, TT, PRL, E2, testicular volume and age were not found to be correlated with successful sperm recovery. The area under the receiving operating characteristic (ROC) curve (AUC) for FSH was determined to be 0.721. Using an FSH cut-off point of 12.95 mIU/mL according to Youden’s index, the model for predicting successful sperm retrieval was found to have 51.4% sensitivity, 84.6% specificity, 90.5% positive predictive value (PPV) and 37.9% negative predictive value (NPV). CONCLUSIONS: Men exhibiting AZFc microdeletion with discernible spermatogenesis from whom sperm was successfully retrieved by mTESE generally presented with relatively lower FSH levels. Source of Funding: nil © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e347-e347 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information I-Shen Huang More articles by this author Wei-Jen Chen More articles by this author William J Huang More articles by this author Expand All Advertisement Loading ...

MP31-05 PREDICTION OF MICRODISSECTION TESTICULAR SPERM EXTRACTION OUTCOME IN POST-CHEMOTHERAPY AZOOSPERMIC MEN USING CYCLOPHOSPHAMIDE EQUIVALENT DOSE

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-05 PREDICTION OF MICRODISSECTION TESTICULAR SPERM EXTRACTION OUTCOME IN POST-CHEMOTHERAPY AZOOSPERMIC MEN USING CYCLOPHOSPHAMIDE EQUIVALENT DOSE Shi-Jie Tsai, I-shen Huang, and William J. Huang Shi-Jie Tsai Shi-Jie Tsai More articles by this author , I-shen HuangI-shen Huang More articles by this author , and William J. HuangWilliam J. Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cancer per se or therapies, particularly treatment involved with chemotherapy, appears to potentiate gonadal toxicity. For men with persistent postchemotherapy azoospermia, fatherhood can be possibly achieved via microdissection testicular sperm extraction (mTESE) combine with intracytoplasmic sperm injection (ICSI). Yet, the recovery of viable testicular sperm with mTESE is unpredictable in this population. Using cyclophosphamide equivalent dose (CED) as a means of quantifying exposure to alkylating agent, a cytotoxic agent that has been demonstrated to disrupt spermatogenesis, we sought to discover the sperm retrieval rate in men with persistent azoospermia postchemotherapy in relation to CED. METHODS: We retrospectively reviewed records of 910 patients with the diagnosis of non-obstructive azoospermia who had undergone mTESE between 2010 to 2018 in our institution and enrolled 14 patients with a prior history of chemotherapy. The oncological data and chemotherapy regimen of each individual were reviewed. For each patient’s regimen received, a CED was calculated using the equation proposed by Daniel Green et al. in 2014. The pretreatment hormone profile, CED, and outcomes of mTESE were analyzed. RESULTS: Testicular spermatozoa were successfully retrieved in 6 (43%) of the patients. The mean patient age was 36 years (range, 27-42 years) and the mean time interval from chemotherapy to mTESE was 10.4 years (range, 1-26 years). Although CED and alkylating agent exposure were not predictive factors for successful sperm retrieval (p=0.14), however, no men with CED >4000 mg/m2 (n=4) had viable sperm detected in testis during mTESE. As for the other 10 patients without alkylating agent exposure (i.e. CED=0 mg/m2), sperm can be recovered in 6 (60%) of them. Regarding cancer subtypes, patients diagnosed with testicular non-seminomatous germ cell tumor had favorable sperm retrieval rate (3/5, 60%), compared to patients with non-Hodgkin’s lymphoma (0/3, 0%) or leukemia (1/2, 50%), respectively. CONCLUSIONS: The chance of successful sperm retrieval using mTESE for men with persistent postchemotherapy azoospermia and a calculated CED >4000 mg/m2 is zero. These patients should be properly counseled with the CED model before pursuing surgical sperm retrieval . Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e556-e557 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shi-Jie Tsai More articles by this author I-shen Huang More articles by this author William J. Huang More articles by this author Expand All Advertisement Loading ...

Analysis of factors affecting repeat microdissection testicular sperm extraction outcomes in infertile men.

There is no clear consensus on which patients and how many of microscopic testicular sperm extraction (mTESE) procedures will be successful. In this study, we aimed to evaluate the sperm retrieval rates and factors affecting these rates in men who underwent repeat mTESEs. A total of 346 patients who underwent mTESE for sperm retrieval were included in the study. Patients were divided into groups according to the number of mTESE operations. Patients' karyotype, follicle-stimulating hormone (FSH) and testosterone levels, varicocele presence, and testis volumes were recorded from patient files. The sperm retrieval rates were compared between groups, and predicting factors for successful sperm retrieval were evaluated. Microscopic TESE was applied for the first time in 244 patients, 1-2 times in 73 patients, and 3-4 times in 29 patients. There was a significant difference between groups in preoperative FSH values and postoperative testicular histopathology (p=0.004 and p<0.001). The sperm retrieval rate in the group of patients who had not undergone previous TESE was higher than the group of patients that had undergone TESE for 1-2 times and 3-4 times (p=0.028). In addition, testicular volume, histology, karyotype, and Y-chromosome microdeletion were predicting factors for successful sperm retrieval (p=0.011, p=0.039, p=0.002, and p<0.001, respectively). Our results confirm the necessity for repeat mTESE operations to be performed by experienced surgeons in reference centers to optimize the chance of reduced sperm retrieval rates with recurrent biopsies.

Can Testicular Size Be a Predictive Factor for Successful Sperm Retrieval in Patients with Non Obstructive Azoospermia?

Objective: Non-obstructive azoospermia, defined as absence of spermatozoa in the ejaculate caused by impaired spermatogenesis, is the most severe cause of male infertility. It is typically presented as high serum follicle stimulating hormone levels and atrophic testis. The combination of intracytoplasmic sperm injection and Microdissection testicular sperm extraction allows these infertile men the opportunity to have their own children from their own testis. Our aim was to evaluate the outcomes of micro-Testicular sperm extraction in men with atrophic testis.Study Design: The medical records of 80 non-obstructive men with azoospermia who underwent micro-TESE were retrospectively evaluated. We assessed clinical parameters; age, duration of infertility, smoking, chromosomal karyotype, Y chromosome microdeletion, follicle stimulating hormone, luteinizing hormone, total testosterone and testicular volume in relation with Microdissection testicular sperm extraction results.Results: Testicular sperm retrieval rate was 53% in 80 patients. Testicular volume, serum follicle stimulating hormone and total testosterone concentrations showed correlation with the results of sperm retrieval. These three parameters were found to be significant risk factors with testicular sperm extraction negative patients (p&lt;0.001). The odds ratios (95% CI) were 6.39 (1.25–26.58), 1.24 (1.11-1.36), 1.13 (0.99-1.21) respectively. Testicular volume was found to be a discriminative parameter in patients with negative sperm retrieval. The cut-off point was established as 6.75 ml for testicular volume with 88.1% sensitivity, 62.1% specificity.Conclusion: Microdissection testicular sperm extraction is the most effective procedure for patients with non-obstructive azoospermia. Testicular volume, serum follicle stimulating hormone and testosterone levels can be predictive factors for sperm retrieval in men with non-obstructive azoospermia.

AMH is a predictive factor for successful sperm retrieval in non-mosaic Klinefelter syndrome patients

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Testicular histopathology, semen analysis and FSH, predictive value of sperm retrieval: supportive counseling in case of reoperation after testicular sperm extraction (TESE)

BackgroundTo provide indicators for the likelihood of sperm retrieval in patients undergoing testicular sperm extraction is a major issue in the management of male infertility by TESE. The aim of our study was to determine the impact of different parameters, including testicular histopathology, on sperm retrieval in case of reoperation in patients undergoing testicular sperm extraction.MethodsWe retrospectively analyzed 486 patients who underwent sperm extraction for intracytoplasmic sperm injection and testicular biopsy. Histology was classified into: normal spermatogenesis; hypospermatogenesis (reduction in the number of normal spermatogenetic cells); maturation arrest (absence of the later stages of spermatogenesis); and Sertoli cell only (absence of germ cells). Semen analysis and serum FSH, LH and testosterone were measured.ResultsFour hundred thirty patients had non obstructive azoospermia, 53 severe oligozoospermia and 3 necrozoospermia. There were 307 (63%) successful sperm retrieval. Higher testicular volume, lower levels of FSH, and better histological features were predictive for sperm retrieval. The same parameters and younger age were predictive factors for shorter time for sperm recovery. After multivariable analysis, younger age, better semen parameters, better histological features and lower values of FSH remained predictive for shorter time for sperm retrieval while better semen and histology remained predictive factors for successful sperm retrieval. The predictive capacity of a score obtained by summing the points assigned for selected predictors (1 point for Sertoli cell only, 0.33 points for azoospermia, 0.004 points for each FSH mIU/ml) gave an area under the ROC curve of 0.843.ConclusionsThis model can help the practitioner with counseling infertile men by reliably predicting the chance of obtaining spermatozoa with testicular sperm extraction when a repeat attempt is planned.

MP19-08 AGE AND PARTIAL AZFC DELETION DO NOT PREDICT SPERM RETRIEVAL IN NON-MOSAIC KLINEFELTER PATIENTS

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II1 Apr 2018MP19-08 AGE AND PARTIAL AZFC DELETION DO NOT PREDICT SPERM RETRIEVAL IN NON-MOSAIC KLINEFELTER PATIENTS I-shen Huang, William J Huang, James Wren, Nelson E Bennett, and Robert E Brannigan I-shen HuangI-shen Huang More articles by this author , William J HuangWilliam J Huang More articles by this author , James WrenJames Wren More articles by this author , Nelson E BennettNelson E Bennett More articles by this author , and Robert E BranniganRobert E Brannigan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.657AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical testicular sperm retrieval (mTESE) provided the best way for sperm retrieval in nonmosaic 47, XXY men with azoospermia. Age and testosterone levels after treatment are prognostic factors for successful sperm retrieval. Whether Y chromosome deletion determine the sperm retrieval rate in non-mosaic Klinefelter patient has not been addressed. The objective of this study was to evaluate the prognostic factors for sperm retrieval and determine if Y chromosome deletion could lead to deleterious effect. METHODS The medical records of azoospermic patients were retrospectively collected from Sep 2009 to July 2017, and enrolled 53 non-mosaic 47,XXY patients receiving mTESE. The predictive values of patients age, serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin, estradiol and Y chromosome deletion testing were assessed for successful sperm recovery. The Student’s t test was used to compare hormone profiles and Fisher’s exact test was used for comparison of Y chromosome deletion among the sperm retrieval successful and failure groups. RESULTS Testicular sperm recovery was successful in 20 (37.7%) of 53 men. The mean levels of age (35.9 vs. 36.8 years), FSH (30.8 vs 37.5 IU/L), LH (17.5 vs 22.5 IU/L), testosterone (2.1 vs. 2.2 ng/ml), prolactin (9.1 vs. 8.8 ng/ml) and estradiol (19.4 vs. 22.3 pg/ml) did not show any significant difference comparing with patients with and without successful sperm retrieval. Sperm retrieval rate was comparable for patient below (36.4%) or above (37.5%) 35 years old. The partial azoospermic factor c (AZFc) deletion was noticed in 4 (20%) of 20 patients with successful sperm retrieval, including two sY1191 and two sY1291 deletion cases, whereas 4 (12.1%) of 33 patients was noted to have AZFc partial deletion (one sY1191, one sY1206 and two sY1291), but the difference was not statistically significant (p= 0.46) CONCLUSIONS According to present results, age and AZFc partial deletion status should not be the reason to discourage azoospermic non-mosaic 47,XXY men for receiving mTESE. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e247 Advertisement Copyright & Permissions© 2018MetricsAuthor Information I-shen Huang More articles by this author William J Huang More articles by this author James Wren More articles by this author Nelson E Bennett More articles by this author Robert E Brannigan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sperm retrieval by microdissection testicular sperm extraction and intracytoplasmic sperm injection outcomes in nonobstructive azoospermic patients with Klinefelter syndrome.

Klinefelter syndrome is the most frequent chromosomal abnormality in patients with nonobstructive azoospermia. The development of advanced assisted reproductive techniques, such as testicular sperm extraction and intracytoplasmic sperm injection, has provided the possibility of biological fathering in nonobstructive azoospermic patients with Klinefelter syndrome. We aimed to evaluate our sperm retrieval rate by microdissection testicular sperm extraction and to analyse the intracytoplasmic sperm injection outcomes in these patients. Medical records of 110 nonobstructive azoospermic patients with Klinefelter syndrome were retrospectively reviewed. We found that the sperm retrieval rate by microdissection testicular sperm extraction is lower than published reports on other types of secretory azoospermia. The statistical analyses yielded that age, FSH and testosterone levels as predictive factors for successful sperm retrieval.

The predictive value of parameters of clinical presentations for sperm yield in patients with nonobstructive azoospermia receiving microdissection testicular sperm extraction

ObjectiveWe analyzed a cohort of nonobstructive azoospermia (NOA) patients receiving microdissection testicular sperm extraction (mTESE) to examine the relationship of sperm yield and the parameters of clinical presentations. We aim to identify the parameters that might positively predict a positive sperm yield after mTESE. Materials and methodsA total of 200 patients with NOA who had undergone mTESE were enrolled. Among them, 112 (56%) had received a prior testicular needle biopsy. Clinical data including physical findings, underlying genetic abnormalities, pathologic findings in needle biopsy, and sperm retrieval rate (SRR) during mTESE were reviewed and analyzed. ResultsThe pathological findings of prior needle biopsy demonstrate a predictive value of sperm yield during mTESE. Hypospermatogenesis had SRR of 93.3% during mTESE, early maturation arrest had SRR of 13.3%, late maturation arrest (LMA) had SRR of 66.7%, and Sertoli cell-only syndrome had SRR of 18.1%. Regarding parameters of clinical presentation, we found that SRR during mTESE was 85.7% for patients with hypogonadotropic hypogonadism, 60.0% for men with undescended testes (UDT) history, 50.0% for patients who had been exposed to chemotherapeutics due to malignancy of other organs, 100% for prior mumps infection, 50.0% for AZFc deletion, 50.0% for Klinefelter syndrome, and 33.3% for other sex chromosome-related abnormalities. No sperm was found in patients with AZFa or AZFb microdeletion. The consistency of histopathological findings between initial testis biopsy and mTESE was 77.7%. As much as 17.4% of cases had upgraded on spermatogenesis at later mTESE. ConclusionClinical presentations or phenotypes can be used as predictive factors for successful sperm retrieval during mTESE in patients with NOA. Hypogonadotropic hypogonadism and cases with UDT history have a higher chance of sperm retrieval. Initial testicular needle biopsy, if available, can provide valuable information about chances of sperm retrieval. Hypospermatogenesis predicts high sperm yield rate, and LMA can have best upgrade results of sperm yield after mTESE.

Age as a Limiting Factor for Successful Sperm Retrieval in Patients With Nonmosaic Klinefelter's Syndrome

Age as a Limiting Factor for Successful Sperm Retrieval in Patients With Nonmosaic Klinefelter's Syndrome

Age as a limiting factor for successful sperm retrieval in patients with nonmosaic Klinefelter’s syndrome

To determine factors affecting successful sperm retrieval by testicular sperm extraction in patients with nonmosaic Klinefelter's syndrome. Medical record analysis for nonmosaic Klinefelter's syndrome patients who underwent testicular sperm extraction. Three university-based tertiary centers. Fifty-one patients with nonobstructive azoospermia related to nonmosaic Klinefelter's syndrome. Testicular sperm extraction. Correlation of patient characteristics; serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (T); as well as testicular volume with success in testicular sperm extraction. We succeeded in obtaining spermatozoa in 26 patients and failed in 25. Levels of LH, FSH, and T and testicular volume did not differ between patient groups defined by success and failure. Median ages for successful and failed testicular sperm extraction were 31 and 38 years, respectively (statistically significant difference). When we analyzed success rates of testicular sperm extraction between two patient groups (<35 and > or =35 years old), the percentage of successful recovery of spermatozoa decreased after the age of 35 years (statistically significant difference). Testicular sperm extraction should be recommended before the critical age of 35 years.

Age as a Limiting Factor for Successful Sperm Retrieval in Nonmosaic Klinefelter Syndrome

Intracytoplasmic sperm injection (ICSI) now permits fertilization of eggs using very small numbers of spermatozoa. Improvements in testicular sperm extraction (TESE) techniques have expanded indications from oligozoospermia to nonobstructive azoospermia. Klinefelter syndrome, which accounts for 5% of the latter cases, is characterized by sterility caused by lack of spermatogenesis. Isolated foci of spermatogenesis have been found in involved testes, explaining the rare cases of sperm production with appearance in the ejaculate. Several institutions perform TESE using either ordinary testicular biopsy techniques or meticulous microdissection to retrieve spermatozoa for ICSI. The reported success rate for TESE in patients with Klinefelter syndrome is 56%, but no predictive factors have been identified given the paucity of cases in each report. We analyzed results of TESE to elucidate success determinants for TESE in patients with Klinefelter syndrome. Retrospective analysis of microdissection TESE in nonmosaic Klinefelter syndrome patients. A collaborative study with three institutions. Eighty-four patients with nonobstructive azoospermia related to nonmosaic Klinefelter syndrome underwent TESE. To determine factors affecting successful sperm retrieval by TESE in patients with nonmosaic Klinefelter syndrome medical record were analyzed retrospectively. Correlations of patient characteristics, serum concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), and testosterone (T), as well as testicular volume with success in testicular sperm extraction were investigated. We succeeded in obtaining spermatozoa in 51 patients and failed in 33. LH, FSH, T, and testicular volume did not differ between patient groups defined by success and failure. Median ages for successful and failed TESE were 32.6 and 37.1, respectively (p<0.001). When we analyzed success rates of testicular sperm extraction for 5-year age brackets, the ratio of successful recovery of spermatozoa to failure decreased beyond 35 years. Testicular sperm extraction should be recommended before the critical age of 35 in nonmosaic Klinefelter syndrome patients.

1934: Age is the Limiting Factor for Successful Sperm Retrieval in Nonmosaic Klinefelter Syndrome

1934: Age is the Limiting Factor for Successful Sperm Retrieval in Nonmosaic Klinefelter Syndrome

Can a successful testicular sperm recovery be predicted in 47,XXY klinefelter patients?

Objective: To assess the availability of predictive factors for successful sperm retrieval in 47,XXY Klinefelter patients. Design: Retrospective, consecutive case series. Materials and Methods: We performed sperm recovery procedures in 50 non-mozaic Klinefelter patients who did not receive androgen substitution therapy. The predictive power of clinical parameters such as age, largest testicular volume, FSH, FSH/LH ratio, testosterone and androgen sensitivity index for successful testicular sperm retrieval was analyzed using the receiver operating characteristics (ROC) curve analysis. Results: In 24 out of these 50 patients (48%) testicular spermatozoa were recovered. The mean FSH and testosterone values in patients with sperm was 31.2 IU/L and 3.1 ng/ml vs. 40.4 IU/L and 3.2 ng/ml in patients without sperm. The mean testicular volume of the largest testis in patients with sperm found was 4.2 ml vs. 3.6 ml in patients with no sperm found. The best discriminating age was 31 years (sensitivity 75.0%, specificity 61.5%) with an area under the ROC curve (AUC) of 0.67. The best discriminating FSH value was 33.2 IU/L (sensitivity 68.2%, specificity 70.8%) with an AUC of 0.68. The best discriminating testosterone value was 2.2 ng/ml (sensitivity 70.6%, specificity 43.5%) with an AUC of 0.51. The best discriminating FSH/LH ratio was 1.4 (sensitivity 47.1%, specificity 82.6%) with an AUC of 0.59. The best discriminating androgen sensitivity index (LH x testosterone) was 76.8 (sensitivity 87.5%, specificity 40.9%) with an AUC of 0.61. Ninety-four percent of the men in whom sperm was found had a normal facial hair pattern compared to 93% in whom no sperm was recovered (NS). Seventeen percent of the men with successful testicular sperm extraction had gynecomastia compared to 31% of the men with failed testicular sperm extraction (NS). Conclusion: As in the general population of men with non-obstructive azoospermia, there are currently no factors predicting successful sperm retrieval in this subpopulation of patients with non-mozaic Klinefelter syndrome.

Possible predictive factors for ICSI? Molecular biology techniques in combination with therapeutic testicular biopsies.

Applying intracytoplasmic sperm injection (ICSI), the selection of an unsuccessful spermatozoon results in great emotional consequences for the couple. Therefore, there is a need for a prognostic parameter to estimate their chances for successful fertility treatment. This review summarizes both the main reasons for spermatogenic impairment, and possible predictive factors for successful sperm retrieval applying testicular sperm extraction and outcome of ICSI. While basic sperm parameters, aetiology and type of spermatozoa, and serum follicle-stimulating hormone and inhibin levels have been shown to be unrelated to the outcome of ICSI, Y-chromosome microdeletions are known to have a negative influence on the fertilizing capacity of spermatozoa. Recently, a significant correlation has been reported between the protamine-1 to protamine-2 mRNA ratio in haploid spermatids of testicular biopsies and the ability of spermatozoa for successful fertilization of an oocyte. In future, both the outstanding role of the haploid spermatids and the involvement of molecular biological techniques will improve the role of therapeutic testicular biopsies.