The fertility preservation decision-making and testicular sperm retrieval outcome in older adolescents with nonmosaic Klinefelter syndrome and azoospermia

Abstract

Background: This study aims to analyze the fertility preservation decision-making and the sperm retrieval rate (SRR) in older adolescents (age 15–19 years) with nonmosaic Klinefelter syndrome (KS) and azoospermia in a male reproductive clinic, and to determine the accumulated SRR in older adolescents by literature review. Methods: Older adolescents with nonmosaic KS and azoospermia referred for hypogonadism and fertility concerns were enrolled. Reproductive counseling and fertility preservation options were offered to patients/parents. The acceptability and the reasons affecting the reproductive decision-making were analyzed. Patients/parents who agreed on fertility preservation received microdissection testicular sperm extraction (mTESE) and cryopreservation. A comprehensive literature review regarding the SRRs in older adolescents with KS was conducted. Results: A total of eight older adolescents were enrolled. After fertility preservation counseling, three patients/parents (37.5%) agreed to receive mTESE, and spermatozoa were successfully retrieved in two. “Lack of interest” and “inconsistent sperm retrieval result” were the main reasons for refusal. A total of 89 older adolescents from nine articles, and ours were collected for SRR analysis. Most of the reports had a limited number of cases, and none of them described the acceptance rate of sperm retrieval in adolescents. Forty-three out of 89 older adolescents (48.3%) had successful sperm retrieval, and there was no significant difference in the SRR between the mTESE and conventional TESE. Conclusion: Successful testicular sperm retrieval in older adolescents with KS is not superior to those reported in adults. Adolescents and their parents should undergo a detailed reproductive consultation process and shared decision-making discussion before considering testicular sperm retrieval.

Age, Sperm Retrieval, and Testicular Histology in Klinefelter Syndrome

“…These data are not surprising as conflicting SRRs in adolescent and adult KS males has been reported by various groups. 1,8-10 No significant difference in SRR was noted between early and late adolescents. In the 20 to 29–year-old cohort, sperm were isolated in 71% of cases, despite only approximately 15% exhibiting germ cell–containing histology on testis biopsy.…”

“…7 Sperm retrieval rates (SRRs) in adolescent KS males are reported to range from 0% to 70%, whereas the SRR in adult KS males ranges from 20% to 72%. 1,4,8-10 Consideration for sperm retrieval in adolescents is led by the concern for progressive germ cell loss, as well as the use of testosterone supplementation which may suppress spermatogenesis and fertility. 1,9,11…”

“…7 Sperm retrieval rates (SRRs) in adolescent KS males are reported to range from 0% to 70%, whereas the SRR in adult KS males ranges from 20% to 72%. 1,4,[8][9][10] Consideration for sperm retrieval in adolescents is led by the concern for progressive germ cell loss, as well as the use of testosterone supplementation which may suppress spermatogenesis and fertility. 1,9,11 Although sperm retrieval in adolescent KS males is not commonly performed, the optimal age at which surgery should be performed to increase the chance of sperm retrieval has not been defined.…”