title: Testicular Sperm Sampling by Subcapsular Orchiectomy in Klinefelter Patients: A New Simplified Treatment Approach.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre of Andrology, Fertility Clinic, Odense University Hospital, Odense C, Denmark; Laboratory of Reproductive Biology, Scientific Unit, Horsens Hospital, Horsens, Denmark. Electronic address: fedder@dadlnet.dk.
authors.forename: Jens
authors.initials: J
authors.lastname: Fedder
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark; Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Claus H
authors.initials: CH
authors.lastname: Gravholt
authors.affiliation: Laboratory of Reproductive Biology, University Hospital of Copenhagen (Rigshospitalet), Copenhagen Ø, Denmark.
authors.forename: Stine Gry
authors.initials: SG
authors.lastname: Kristensen
authors.affiliation: Centre of Andrology, Department of Pathology, Odense University Hospital, Odense C, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Marcussen
authors.affiliation: Centre of Andrology, Department of Pathology, Odense University Hospital, Odense C, Denmark.
authors.forename: Birte
authors.initials: B
authors.lastname: Engvad
authors.affiliation: Centre of Andrology, Fertility Clinic, Odense University Hospital, Odense C, Denmark.
authors.forename: Ann Mains
authors.initials: AM
authors.lastname: Milton
authors.affiliation: Laboratory of Reproductive Biology, University Hospital of Copenhagen (Rigshospitalet), Copenhagen Ø, Denmark.
authors.forename: Claus Yding
authors.initials: CY
authors.lastname: Andersen
mesh_terms: D000293:Adolescent; D000328:Adult; D015925:Cryopreservation; D005260:Female; D006801:Humans; D007713:Klinefelter Syndrome / Q000601:surgery*; D008297:Male; D009919:Orchiectomy / Q000379:methods*; D010865:Pilot Projects; D011247:Pregnancy; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods; D053625:Sperm Retrieval; D055815:Young Adult