Success of testicular sperm extraction [corrected] and intracytoplasmic sperm injection in men with Klinefelter syndrome.
OBJECTIVE
The aim of this study was to report the successful fertility treatment of men with Klinefelter syndrome using testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI).


METHODS
A total of 42 men with Klinefelter syndrome who underwent 54 TESE procedures were identified. Before TESE, patients with serum testosterone levels less than 15.6 nmol/liter were treated with an aromatase inhibitor. Sperm retrieval rates and results of ICSI, including fertilization and clinical pregnancy, were collected.


RESULTS
Mean pretreatment FSH and testosterone levels were 33.2 IU/liter and 9.8 nmol/liter. During medical therapy, the mean testosterone level rose to 17.0 nmol/liter (P < 0.01). Spermatozoa were found during 39 microdissection TESE procedures, on the day before, or day of oocyte retrieval during a programmed in vitro fertilization cycle. The sperm retrieval rate was 72% (39 of 54) per TESE attempt, and 29 of the 42 different men (69%) had adequate sperm found for ICSI. Thirty-three in vitro fertilization cycles yielded embryos for transfer in the 39 (85%) cycles with sperm retrieved. Eighteen clinical pregnancies have resulted in 21 live births [18 of 39 (46%)]. All children had a normal karyotype.


CONCLUSIONS
TESE/ICSI is a successful intervention for the majority of patients with azoospermia and Klinefelter syndrome. Sperm retrieval and ICSI success in men with Klinefelter syndrome are comparable with other men with nonobstructive azoospermia treated at our center.
Schiff
Jonathan D
JD
The James Buchanan Brady Foundation, Department of Urology, and The Center for Reproductive Medicine and Infertility, The New York-Weill Cornell Medical Center, and the Population Council, New York, New York 10021, USA.
Palermo
Gianpiero D
GD
Veeck
Lucinda L
LL
Goldstein
Marc
M
Rosenwaks
Zev
Z
Schlegel
Peter N
PN
D000328:Adult; D005260:Female; D006801:Humans; D007713:Klinefelter Syndrome / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D013094:Spermatozoa; D013737:Testis / Q000166:cytology*; D013738:Testolactone / Q000627:therapeutic use; D013739:Testosterone / Q000097:blood
D013739:Testosterone; D013738:Testolactone