Successful Fertility Treatment for Klinefelter's Syndrome
Successful Fertility Treatment for Klinefelter's Syndrome
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DOI：
10.1016/j.juro.2009.05.019
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发表时间：
2009-09-01
影响因子：
6.6
通讯作者：
Schlegel, Peter N.
中科院分区：
文献类型：
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作者：
Ramasamy, Ranjith;Ricci, Joseph A.;Schlegel, Peter N.
目的：我们研究了无精子症和非镶嵌型克氏综合征患者手术前预测显微分离取精术成功与否的因素。我们还分析了术前激素治疗对精子获取率的影响。材料和方法：对68例非镶嵌型克氏综合征患者进行了91次睾丸显微解剖取精。血清睾酮低于300 ng/dl的男性在显微切割睾丸精子前接受芳香酶抑制剂、克罗米芬或人绒毛膜促性腺激素的药物治疗。在手术成功和失败的患者中，比较了患者年龄和内分泌数据的术前因素。主要观察指标为精子获取率。结果：45例男性(66%)成功获取睾丸精子，62次(68%)取精。男性年龄的增加与精子取回率降低的趋势有关(p=0.05)。不同类型的术前激素治疗没有不同的精子取回率，但基线睾酮正常的男性精子取回率最高，为86%。需要药物治疗并且治疗后睾酮水平在250 ng/dl或更高的患者的精子取回率高于治疗后睾酮低于250 ng/dl的男性(77%对55%)。体外受精取精的临床妊娠率为57%，活产率为45%。结论：显微分离睾丸取精术是治疗克氏综合征的一种有效的取精方法。对药物治疗有反应的性腺功能减退症男性可能有更好的机会取回精子。
Purpose: We examined preoperative factors that could predict successful microdissection testicular sperm extraction in men with azoospermia and nonmosaic Klinefelter's syndrome. We also analyzed the influence of preoperative hormonal therapy on the sperm retrieval rate.Materials and Methods: A total of 91 microdissection testicular sperm extraction attempts were done in 68 men with nonmosaic Klinefelter's syndrome. Men with serum testosterone less than 300 ng/dl received medical therapy with aromatase inhibitors, clomiphene or human chorionic gonadotropin before microdissection testicular sperm extraction. Preoperative factors of patient age and endocrinological data were compared in those in whom the procedure was and was not successful. The sperm retrieval rate was the main outcome. Clinical pregnancy (pregnancy with heartbeat) and the live birth rate were also calculated.Results: Testicular spermatozoa were successfully retrieved in 45 men (66%), representing 62 (68%) attempts. Increasing male age was associated with a trend toward a lower sperm retrieval rate (p = 0.05). The various types of preoperative hormonal therapies did not have different sperm retrieval rates but men with normal baseline testosterone had the best sperm retrieval rate of 86%. Patients who required medical therapy and responded to that treatment with a resultant testosterone of 250 ng/dl or higher had a higher sperm retrieval rate than men in whom posttreatment testosterone was less than 250 ng/dl (77% vs 55%). For in vitro fertilization attempts in which sperm were retrieved the clinical pregnancy and live birth rates were 57% and 45%, respectively.Conclusions: Microdissection testicular sperm extraction is an effective sperm retrieval technique in men with Klinefelter's syndrome. Men with hypogonadism who respond to medical therapy may have a better chance of sperm retrieval.