Testicular Sperm Sampling by Subcapsular Orchiectomy in Klinefelter Patients: A New Simplified Treatment Approach
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Testicular Sperm Sampling by Subcapsular Orchiectomy in Klinefelter Patients : A New Simplified Treatment Approach. / Fedder, Jens; Gravholt, Claus H; Kristensen, Stine Gry; Marcussen, Niels; Engvad, Birte; Milton, Ann Mains; Andersen, Claus Yding.
I: Urology, Bind 86, Nr. 4, 10.2015, s. 744-50.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Testicular Sperm Sampling by Subcapsular Orchiectomy in Klinefelter Patients
T2 - A New Simplified Treatment Approach
AU - Fedder, Jens
AU - Gravholt, Claus H
AU - Kristensen, Stine Gry
AU - Marcussen, Niels
AU - Engvad, Birte
AU - Milton, Ann Mains
AU - Andersen, Claus Yding
N1 - Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
PY - 2015/10
Y1 - 2015/10
N2 - 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.CONCLUSION: 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.
AB - 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.CONCLUSION: 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.
KW - Adolescent
KW - Adult
KW - Cryopreservation
KW - Female
KW - Humans
KW - Klinefelter Syndrome
KW - Male
KW - Orchiectomy
KW - Pilot Projects
KW - Pregnancy
KW - Sperm Injections, Intracytoplasmic
KW - Sperm Retrieval
KW - Young Adult
U2 - 10.1016/j.urology.2015.06.044
DO - 10.1016/j.urology.2015.06.044
M3 - Journal article
C2 - 26254174
VL - 86
SP - 744
EP - 750
JO - Urology
JF - Urology
SN - 0090-4295
IS - 4
ER -
ID: 162758347