Sperm recovery and ICSI outcomes in Klinefelter syndrome: a systematic review and meta-analysis

Corona, Giovanni; Pizzocaro, Alessandro; Lanfranco, Fabio; Garolla, Andrea; Pelliccione, Fiore; Vignozzi, Linda; Ferlin, Alberto; Foresta, Carlo; Jannini, Emmanuele A.; Maggi, Mario; Lenzi, Andrea; Pasquali, Daniela; Francavilla, Sandro

doi:10.1093/humupd/dmx008

Cited by 231 publications

(189 citation statements)

References 65 publications

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“…These patients with spermatozoa with maturation arrest had a higher frequency of genetic anomalies, compared to NOA patients . Male age also is considered to be a predictive factor in KS cases . The hormonal level indication is not intended to set the criteria for the positive or negative result of sperm retrieval; it is important to comprehend the patient's background by receiving adequate patient information prior to surgery.…”

Section: Discussionmentioning

confidence: 99%

Long‐term clinical outcomes of testicular sperm extraction and intracytoplasmic sperm injection for infertile men

Okuyama

Obata

Oka

et al. 2017

Reprod Medicine & Biology

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PurposeTo find the best methods to achieve the highest pregnancy and birth rates for couples needing testicular sperm extraction (TESE)‐intracytoplasmic sperm injection (ICSI).MethodsRetrospectively studied were 801 patients with male factor infertility who had undergone TESE‐ICSI between April, 1996 and July, 2016 and who had been categorized into four groups: obstructive azoospermia (OA); non‐obstructive azoospermia (NOA); Klinefelter syndrome (KS); and cryptozoospermia (Crypt). The sperm retrieval rate, hormone levels, fertilization rate (FR), pregnancy rate (PR), and birth rate (BR) after ICSI among three groups were compared: fresh testicular sperm (FS)‐fresh oocytes (FO) (Group I); frozen‐thawed testicular sperm‐FO (Group II); and FS‐vitrified‐warmed oocytes (Group III).ResultsThe testicular sperm recovery rate was 57.8% (463/801): 89.6% in the Crypt, 97.1% in the OA, 28.9% in the NOA, and 42.2% in the KS groups. The follicle‐stimulating hormone levels were significantly higher in the NOA and KS groups and the testosterone levels were significantly lower in the KS group. The FR, PR, and BR were: 65.2%, 43.2%, and 28.5% in group I; 59.2%, 33.4%, and 18.7% in group II; and 56.4%, 33.8%, and 22.1% in group III.ConclusionIntracytoplasmic sperm injection with FS‐FO achieved the best PR and BR. It should be considered what to do in cases with no testicular sperm by TESE. The authors hope that ICSI with donor sperm will be allowed in Japan in the near future.

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Section: Discussionmentioning

confidence: 99%

Long‐term clinical outcomes of testicular sperm extraction and intracytoplasmic sperm injection for infertile men

Okuyama

Obata

Oka

et al. 2017

Reprod Medicine & Biology

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“…A recent review reported by Majzoub et al indicated that publications from many different centers documented sperm retrieval rates (SRRs) in KS adults of approximately 50%‐70%, which are higher than those of general NOA cases, and reported excellent pregnancy rates and healthy 46,XY or 46,XX offspring. A recent meta‐analysis has shown an overall SRR of approximately 40%, ranging from 1% to 50%, in both conventional TESE and micro‐TESE . These results indicate that micro‐TESE, but not conventional TESE, is an ideal method to retrieve sperm from men with KS.…”

Section: Ks and Infertility Treatmentmentioning

confidence: 95%

“…Taking these results together with the biological information that progressive hyalinization of seminiferous tubules is observed after puberty in men with KS, it has been suggested that performing earlier TESE procedures might result in better SRR results . A meta‐analysis has shown that successful SRR in KS patients is independent of age …”

Section: Is Tese During Adolescence Effective In Ks Patients?mentioning

confidence: 99%

Klinefelter syndrome: From pediatrics to geriatrics

Shiraishi

Matsuyama

2018

Reprod Medicine & Biology

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Background Klinefelter syndrome (KS) is one of the major causes of nonobstructive azoospermia (NOA). Microdissection testicular sperm extraction (micro‐TESE) is often performed to retrieve sperm. Infertility specialists have to care for KS patients on a lifelong basis. Methods Based on a literature review and our own experience, male infertility treatment and KS pathophysiology were considered on a lifelong basis. Main findings Patients diagnosed early often have an increased number of aberrant X chromosomes. Cryptorchidism and hypospadias are often found, and surgical correction is required. Cryopreservation of testicular sperm during adolescence is an issue of debate because the sperm retrieval rate (SRR) in KS patients decreases with age. The SRR in adult KS patients is higher than that in other patients with NOA; however, low testosterone levels after micro‐TESE will lower the general health and quality of life. KS men face a number of comorbidities, such as malignancies, metabolic syndrome, diabetes, cardiovascular disease, bone disease, and immune diseases, which ultimately results in increased mortality rates. Conclusion A deeper understanding of the pathophysiology of KS and the histories of KS patients before they seek infertility treatment, during which discussions with multidisciplinary teams are sometimes needed, will help to properly treat these patients.

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“…This group includes patients with Klinefelter syndrome (KS) and Turner syndrome (TS). Males with KS most commonly have a 47,XXY karyotype and impaired spermatogenesis (50). Historically these patients were all thought to be sterile.…”

Section: Impaired Fertility Related To Underlying Medical Conditionsmentioning

confidence: 99%

“…Historically these patients were all thought to be sterile. However, it has been found that some men with KS have a small number of cells that retain the ability to undergo spermatogenesis, and micro-TESE results in sperm retrieval in 50% of men with KS (50,51). With small studies showing no clear benefit of pursuing retrieval in adolescence, the current recommendation is to obtain an ejaculated sample as soon as possible after puberty begins (with cryopreservation of any viable sperm) and to offer micro-TESE at 15-30 years of age (52)(53)(54).…”

Section: Impaired Fertility Related To Underlying Medical Conditionsmentioning

confidence: 99%

Fertility counseling and preservation: considerations for the pediatric endocrinologist

Saraf

Nahata

2017

Transl. Pediatr

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Infertility is a distressing consequence of numerous pediatric medical conditions and treatments.The field of pediatric fertility preservation has expanded rapidly over the past decade, and clinical guidelines emphasize the importance of discussing infertility risk and fertility preservation options with patients and families in a timely manner. Understanding the various mechanisms and presentations of fertility issues across diagnoses is imperative to provide counseling to patients and families, and identify individuals who may benefit from fertility preservation. The goals of this manuscript are to outline current fertility preservation options in pediatrics, review populations at-risk for infertility that are seen in pediatric endocrinology, and discuss other important issues related to fertility preservation including ethical considerations.

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Sperm recovery and ICSI outcomes in Klinefelter syndrome: a systematic review and meta-analysis

Abstract: The present data suggest that performing TESE/micro-TESE in subjects with KS results in SRRs of close to 50%, and then PRs and LBRs of close to 50%, with the results being independent of any clinical or biochemical parameters tested.

Cited by 231 publications

References 65 publications

Long‐term clinical outcomes of testicular sperm extraction and intracytoplasmic sperm injection for infertile men

Long‐term clinical outcomes of testicular sperm extraction and intracytoplasmic sperm injection for infertile men

Klinefelter syndrome: From pediatrics to geriatrics

Fertility counseling and preservation: considerations for the pediatric endocrinologist

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