Testicular Sperm Sampling by Subcapsular Orchiectomy in Klinefelter Patients: A New Simplified Treatment Approach - 01/10/15
, Claus H. Gravholt c, d, Stine Gry Kristensen e, Niels Marcussen f, Birte Engvad f, Ann Mains Milton a, Claus Yding Andersen eAbstract |
Objective |
To evaluate subcapsular orchiectomy as a method to retrieve spermatozoa from minute testicular foci in men with Klinefelter syndrome (KS).
Methods |
Fourteen men with KS were consecutively recruited to unilateral subcapsular orchiectomy. Testicular tissue was dissected mechanically and enzymatically to identify possible sperm. Previous testosterone replacement therapy was interrupted for 10 months (range: 9-12 months) to minimize a possible effect on the spermatogenesis. Two men with high estrogen/testosterone ratios were treated with aromatase inhibitor (letrozol, 2.5 mg/d for 3 months) before operation.
Results |
Testicular sperm were detected in 5 of 14 KS men giving an overall success rate of 36%. The success rate was 50% (5 of 10 men) after exclusion of the 4 men previous treated with androgen substitution. So far, 3 (21%) clinical pregnancies and 2 live births or ongoing pregnancies (14%) have been obtained. Testicular sperm could not be detected in the 2 men treated with aromatase inhibitor before operation. The maximum operative time was 20 minutes, and none had surgical complications such as pain, fever, or hematomas. The mean testosterone level, measured 1-4 months after orchiectomy, decreased to 72% (7.9 ± 2.4 nmol/L) of the preoperative level.
Conclusion |
Subcapsular orchiectomy appears to be easy and quick compared with conventional microtesticular sperm extraction. However, in this pilot study, it has not been possible to demonstrate pregnancy and live birth rates as high as that reported with microtesticular sperm extraction, and further studies are needed before the procedure should be used routinely for sperm retrieval in patients with KS.
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| Financial Disclosure: The authors declare that they have no relevant financial interests. |
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| Funding Support: The study was supported by Laboratory of Reproductive Biology, Scientific Unit, Horsens Hospital, Denmark. |
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| Study Approval: The study has been approved by the Danish Scientific Ethics Committee of Middle Jutland (M−20100041) and the Danish Data Protection Agency (2010-41-4539) and registered at ClinicalTrials.gov (NCT 01750632). |
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| Jens Fedder, Claus H. Gravholt, and Claus Yding Andersen designed the study. Jens Fedder performed the infertility treatment including the orchiectomies. Ann Mains Milton handled the testicular biopsies in the IVF laboratory; Stine Gry Kristensen and Claus Yding Andersen cryopreserved the testicular tissue and made the slides for microscopy. Niels Marcussen and Birte Engvad performed the histologic evaluations. All authors contributed to the final article based on a draft written by Jens Fedder. |
Vol 86 - N° 4
P. 744-750 - octobre 2015 Retour au numéro
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