title: Birth of 16 healthy children after ICSI in cases of nonmosaic Klinefelter syndrome.
abstract: OBJECTIVE
  Does the health status of infants fathered by nonmosaic Klinefelter syndrome (KS) patients whose partners underwent ICSI with sperm obtained from testicular dissection reveal any genetic risk for the offspring?.
  
  
  CONCLUSIONS
  KS patients undergoing testicular sperm extraction (TESE) are capable of conceiving healthy children.
  
  
  BACKGROUND
  Paternity has been successfully achieved in nonmosaic KS patients (47,XXY karyotype) by ICSI using either ejaculated or testicular spermatozoa. A crucial concern is the potential transmission of genetic abnormalities to the offspring. Some studies reported that 47,XXY spermatogonia are capable of completing spermatogenesis leading to the production of mature spermatozoa with increased aneuploidies. Other authors showed that where focal spermatogenesis is present in nonmosaic KS males, it originates from euploid germ cells and, therefore, produces normal mature gametes. In support of this finding, at present, the great majority of children born from nonmosaic KS patients are chromosomally normal.
  
  
  METHODS
  From April 2004 to June 2010, 38 azoospermic patients with nonmosaic KS were examined for the presence of testicular spermatozoa. Spermatozoa were retrieved from 15 patients and 26 ICSI cycles were done (16 with cryopreserved sperm). There were 15 pregnancies leading to the birth of 16 babies who were karyotyped at amniocentesis and after birth.
  
  
  METHODS
  Participants were recruited from couples attending the European Hospital, Rome, and Clinica MAR&Gen, Granada, for infertility treatment. Both the European Hospital and Clinica MAR&Gen are private clinics. Testicular tissue was extracted with TESE or micro-TESE. After retrieval, fresh sperm was used for ICSI or it was cryopreserved for future use.
  
  
  RESULTS
  Spermatozoa were retrieved from 15 patients (14 TESE and 1 micro-TESE) out of 38 (39.5%). A total of 26 ICSI cycles were performed: 10 with fresh and 16 with cryopreserved-thawed sperm. Mean ages (y) of patients with positive and negative sperm retrieval were, respectively, 34.8 ± 1.72 and 35.6 ± 4.08 (NS, nonsignificant). Comparing ICSI cycles performed with fresh sperm (n = 10) to those performed with frozen-thawed sperm (n = 16): Fertilization rates per injected oocyte were 53.0% (44 of 83) and 47.8% (32 of 67), respectively (NS). The cleavage rate per injected oocyte was 90.6% (29 of 32) versus 68.2% (30 of 44); P = 0.026. Clinical outcomes were not significantly different between the fresh and the frozen-thawed sperm group: clinical pregnancy rates were 7 of 10 (70.0%) and 8 of 16 (50.0%); implanted embryos (per transferred embryo) were 8 of 23 (34.8%) and 8 of 29 (27.6%); delivery rates were 6 of 10 (60.0%) and 5 of 16 (31.3%). Sixteen babies were born, all of them are healthy with a normal karyotype, eight from the fresh sperm group and eight from the frozen-thawed sperm group.
  
  
  CONCLUSIONS
  The small numbers available for study mean that only common problems can be excluded.
  
  
  CONCLUSIONS
  This study provides further reassurance that KS men can father healthy children and that pre-implantation genetic diagnosis on embryos conceived with their sperm is not strongly indicated. However, until conclusive information is available, such couples should be offered extensive genetic counseling.
  
  
  BACKGROUND
  No external funding was obtained for the present study. None of the authors has any conflict of interest to declare.
  
  
  BACKGROUND
  Not applicable.
authors.affiliation: Center for Reproductive Medicine, European Hospital, Rome, Italy. ergreco1@virgilio.it
authors.forename: E
authors.initials: E
authors.lastname: Greco
authors.forename: F
authors.initials: F
authors.lastname: Scarselli
authors.forename: M G
authors.initials: MG
authors.lastname: Minasi
authors.forename: V
authors.initials: V
authors.lastname: Casciani
authors.forename: D
authors.initials: D
authors.lastname: Zavaglia
authors.forename: D
authors.initials: D
authors.lastname: Dente
authors.forename: J
authors.initials: J
authors.lastname: Tesarik
authors.forename: G
authors.initials: G
authors.lastname: Franco
mesh_terms: D000328:Adult; D000649:Amniocentesis; D000782:Aneuploidy; D001706:Biopsy; D015925:Cryopreservation; D005220:Fathers; D005260:Female; D006801:Humans; D007621:Karyotyping; D007713:Klinefelter Syndrome / Q000175:diagnosis / Q000235:genetics*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods*; D053625:Sperm Retrieval; D013091:Spermatogenesis; D013094:Spermatozoa / Q000473:pathology; D013737:Testis / Q000601:surgery