A UK multicentre study analysing the surgical sperm retrieval rates in men with non-mosaic Klinefelter's syndrome undergoing mTESE
Johnson, M1; Sangster, P1; Raheem, A1; Zainal, Y1; Poselay, S1; Hallerstrom, M1; Johnson, TF1; Mohammadi, B1; Hafez, K2; Bhandari, C1; Vincens, A2; Yap, T 2; Shabbir, M2; Minhas, S1; Ralph, D1
1: University College London Hospital, United Kingdom; 2: Guy's and St Thomas' Hospital
Objective: A contemporary meta-analysis (Corona et al, 2017) has demonstrated that the surgical sperm retrieval rates (SSR) in men with Klinefelter’s syndrome (KS) undergoing TESE are approximately 50% world wide. Although the data analysis was limited to small single centre case series, a number of confounding variables including demographic, clinical and biochemical factors may affect SSR, including pharmacological stimulation. The aim of this study was to assess these variables from multicenter specialist centres in the UK.
Methods: We retrospectively reviewed 1473 records and identified 73 patients with nonobstructive azoospermia and non mosaic KS who underwent micro-TESE between 2004 and 2016, at 3 tertiary referral centres in the UK. Confounding variables affecting SSR including male age, ethnicity, biochemical/histopathological factors and the effects of hormonal stimulation with aromatase inhibitors pre-SSR were analysed using univariate logistic regressions. All men underwent testicular ultrasound, hormonal and genetic blood testing and biopsies were sent for pathology and Johnson score evaluation.
Results: The prevalence of KS in our population of 4.96%. There was no significant difference in SSR between the Andrology centres. . The mean patients' age was 35.7 years. The mean right testicular volume 2.6cc and left testicular volume was 2.54cc. The overall SRR was 21.2% although sperm was found in 100% of testicles with hypospermatogenesis. Patient age (p=0.42), testicular size (p=0.32), serum FSH (p=0.72), LH (p=0.65), prolactin (p=0.36), and testosterone (p=0.83) had no significant impact on SSR. The age at sperm retrieval did not significantly impact on SSR. Preoperative pharmacological stimulation in 26 men did not increase the rate of SSR (p=0.52).
Conclusion: The SSR in this multicentre UK KS cohort study is inferior to that reported in the contemporary literature. There were no predictive or prognostic factors for SSR in this group or geographical distribution for SSR.
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