What should be the minimum frequency of micro testicular sperm extraction (m-TESE) in patients with Klinefelter syndrome?

Aim: To investigate whether a second or even a third surgery is required for sperm retrieval in non-mosaic Klinefelter syndromepatients who underwent a successful/failed micro-testicular sperm extraction (m-TESE).Material and Methods: The patients underwent physical examination, genetic analyses, pathological screening between 2008 and2018. In the patients, sperm retrieval rates, pregnancy after intracytoplasmic sperm injection (ICSI) and baby take-home rates wereexamined.Results: M-TESE was repeated for the second time in thirty-five patients in total, with twenty of that underwent their first m-TESEwith a negative result and fifteen with a positive result. In =6/20 patients (30%) who had a negative result with the first m-TESEand in n=9/15 patients (60%) who had a positive result with the first m-TESE, sperm was detected the second time. Pregnancy wasachieved in n=2/6 patients (33%) who were negative the first time and positive the second time. Baby take-home was achieved inone patient (16.6%).Conclusion: In addition to patients from whom sperm could be retrieved previously, sperm could be detected especially in the secondand even third redo m-TESE in patients from whom sperm could not be retrieved. Pregnancy occurred and baby take-home wasachieved. Despite the presence of a very limited testicular tissue, it is recommended for this procedure to be performed by expertpractitioners upon discussing very openly the complications and achievements, to decide accordingly and repeat m-TESE in thesepatients where possible.

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1. Klinefelter HF, Reifenstein EC, Albright F. Syndrome characterized by gynecomastia, aspermatogenesis without a-Leydigism, and increased excretion of follicle-stimulating hormone. Am J Clin Dermatol 1942;2:615- 27.
2. Ferhi K, Avakian R, Griveau JF, et al. Age as only predictive factor for successful sperm recovery in patients with Klinefelter’s syndrome. Andrologia 2009;41:84–7.
3. Abramsky L, Chapple J. 47, XXY (Klinefelter syndrome) and, 47, XYY: estimated rates of and indication for postnatal diagnosis with implications for prenatal counselling. Prenat Diagn 1997;17:363-8.
4. Fullerton G, Hamilton M, Maheshwari A. Should nonmosaic Klinefelter syndrome men be labelled as infertile in 2009? Hum Reprod 2010;25:588-97.
5. Devroey P, Van Steirteghem A. A review of ten years experience of ICSI. Hum Reprod Update 2004;10:19- 28.
6. Tuttelman F, Gromoll J. Novel genetic aspects of Klinefelter’s syndrome. Mol Hum Reprod 2010;16:386-95.
7. Ramasamy R, Ricci JA, Palermo GD, et al.Successful fertility treatment for Klinefelter’s syndrome. J Urol 2009;182:1108-13.
8. Tournaye H, Staessen C, Liebaers I, et al.Testicular sperm recovery in nine 47, XXY Klinefelter patients. Hum Reprod 1996;11:1644-9.
9. Palermo GD, Schlegel PN, Sills ES, et al. Births after intracytoplasmic injection of sperm obtained by testicular extraction from men with nonmosaic Klinefelter’s syndrome. N Eng J Med 1998;338:588- 90.
10. Seo JT, Park YS, Lee JS. Successful testicular sperm extraction in Korean Klinefelter syndrome. Urology 2004;64;1208-11.
11. Okada H, Shirakawa T, Ishikawa T, et al. Serum testosterone levels in patients with nonmosaic Klinefelter syndrome after testicular sperm extraction for intracytoplasmic sperm injection. Fertil Steril 2004;82:237-8.
12. Ramasamy R, Yagan N, Schlegel PN. Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 2005;65:1190-4.
13. Okada H, Shirakawa T, Ishikawa T, et al. Serum testosterone levels in patients with nonmosaic Klinefelter syndrome after testicular sperm extraction for intracytoplasmic sperm injection. Fertil Steril 2004;82:237-8.
14. Takada S, Tsujimura A, Ueda T, et al. Androgen decline in patients with nonobstructive azoospermia after microdissection testicular sperm extraction. Urology 2008;72:114-8.