Testicular ultrasonography and extended chromosome analysis in men with nonmosaic Klinefelter syndrome: a prospective study of possible predictive factors for successful sperm recovery.
OBJECTIVE
To investigate whether extended chromosome analysis or testicular sonography, including flow Doppler imaging, before diagnostic testicular sperm extraction have predictive value for successful sperm retrieval in men with nonmosaic Klinefelter syndrome.


METHODS
Prospective clinical study.


METHODS
IVF clinic and genetics laboratory at a university hospital.


METHODS
Nineteen patients with nonmosaic Klinefelter syndrome and azoospermia.


METHODS
Collection of blood samples; histopathologic examination of testicular tissue; fluorescence in situ hybridization; sonography, including Doppler imaging; and testicular sperm extraction.


METHODS
Testicular volume, serum FSH and serum testosterone levels, percentage of normal XY cells, ultrasound echogenicity, intratesticular blood flow resistance, and sperm recovery.


RESULTS
Testicular volume and levels of serum FSH and serum testosterone levels did not differ significantly. No differences in testicular echogenicity or intratesticular blood flow resistance were found between 47,XXY men in whom sperm recovery was successful and those in whom sperm recovery failed. Significant differences were seen between all patients with the Klinefelter syndrome and controls with normal sperm values. Fluorescence in situ hybridization of peripheral lymphocytes and buccal tissue showed no correlation between frequency of normal 46,XY cells and testicular spermatogenesis.


CONCLUSIONS
In azoospermic men with the Klinefelter syndrome, histopathologic findings seem to be predictive for successful sperm recovery. Infertility work-up, including diagnostic testicular sperm recovery, is recommended, and, if possible, viable sperm should be cryopreserved.
Westlander
G
G
Center for Reproductive Medicine, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden. goran.westlander@medfak.gu.se
Ekerhovd
E
E
Granberg
S
S
Hanson
L
L
Hanson
C
C
Bergh
C
C
D000328:Adult; D002610:Cheek / Q000473:pathology; D002874:Chromosome Mapping; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007713:Klinefelter Syndrome / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000473:pathology / Q000503:physiopathology; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009030:Mosaicism; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D012039:Regional Blood Flow; D013048:Specimen Handling; D013091:Spermatogenesis; D013094:Spermatozoa; D013737:Testis / Q000098:blood supply / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D014655:Vascular Resistance