Presentation Authors: Arunan Sujenthiran, James Tracey, Philip Broussil*, Sheryl Homa, Yaser Dajani, Yulia Kopeika, Majed Shabbir, Tet Yap, London, United Kingdom
Introduction: The prevalence of Klinefelter syndrome (KS) (ranging from 0.1 to 0.2% in newborn male infants) rises up to 3-4% among infertile males and 10-12% in azoospermic patients. The most common reproductive abnormality in KS is non-obstructive azoospermia (NOA), and approximately 11% of men with NOA will have KS. With recent advances in reproductive medicine, sperm can be retrieved via surgical testicular sperm extraction (TESE) in around 50% of men seeking biological fertility. This falls in KS according to most studies. Hormone stimulation prior to a sperm retrieval procedure has been used in men with low testosterone levels and infertility. Clomiphene citrate is a selective oestrogen receptor modulator that blocks negative feedback at the level of the hypothalamus and pituitary thus increasing both LH and FSH secretion. HCG and recombinant FSH can also be used for testosterone stimulation is there is limited response to clomiphene citrate. The efficacy of testosterone stimulation and subsequent sperm retrieval in KS is not well documented.
Methods: A prospective multi-centre database was created using every KS patient undergoing micro-TESE between 2014-2018. Demographic details, hormone levels, hormone stimulation treatment (delivered in a step-wise regime for 6 months), sperm retrieval rates, pregnancy rates and live birth rates were recorded.
Results: During the period analysed we had 23 patients with KS who underwent micro-TESE. Median age (IQR) was 33 years old (30-34), median testosterone 8.1 nmol/L (5.3-12.9), median FSH 35.4 IU/L (23.6-38.9) and median LH 22.5 IU/L (16.1-26.8). From this group of patients, 15 had hormone stimulation for 6 months and 8 did not, prior to micro-TESE. In the hormone stimulation group sperm retrieval rates were 40% (6/15) compared to 13% (1/8) in the group without prior stimulation. In the hormone stimulation group pregnancy rates were 27% (4/15) and live birth rates were 20% (3/15).
Conclusions: The use of hormone stimulation in KS patients undergoing micro-TESE appears to improve their pre-surgery testosterone levels and provides a better success rate of sperm retrieval. This has been shown to then result in a high pregnancy and live birth rates compared to other studies.