Microsurgical Sperm Extraction in Patients with Klinefelter Syndrome

Introduction
Men with Klinefelter Syndrome lack spermatozoa in the ejaculate. In
some cases, it is possible to extract spermatozoa using a microsurgical
approach called microdissection testicular sperm extraction (mTESE). In
this study, we investigate the success rate of mTESE in patients with
Klinefelter Syndrome, explore characteristics of identified spermatozoa,
and identify factors associated with successful sperm retrieval.
Methods:
This is a retrospective study using patient records. Patients were included
if they had Klinefelter Syndrome and had undergone mTESE between
09/2017 and 12/2023. Successful mTESE was defined as identification of
spermatozoa suitable for cryopreservation. Statistical analyses were
performed using descriptive statistics and logistic regression.
Results:
Thirty-seven patients were included in the study. Spermatozoa were
successfully retrieved and cryopreserved in 17 cases (46%). The
identified spermatozoa were immotile in 5 cases (29%), non-progressive
motile in 10 cases (59%), and progressive motile in 2 cases (12%). Aside
from a minor defect in the surgical wound, that did not require surgical
intervention, no postoperative complications occurred. Higher
preoperative levels of sex-hormone binding globulin, BMI under 25 kg/m2,
and young age were associated with successful sperm retrieval (p<0,05).
No association between sperm retrieval and preoperative testosterone,
LH, FSH, estradiol, inhibin B, testis volume, and smoking was found.
Conclusion:
Spermatozoa were successfully retrieved in 46% of cases. This is in
concordance with previous studies. Spermatozoa were motile in 71% of
cases. Higher preoperative levels of sex hormone binding globulin, BMI
under 25 kg/m2, and young age were associated with successful sperm
retrieval.