1888 SUCCESSFUL TESTICULAR SPERM RETRIEVAL IN KLINEFELTER ADOLESCENTS TREATED WITH AT LEAST ONE YEAR OF TOPICAL TESTOSTERONE AND AROMATASE INHIBITOR (2013)

You have accessJournal of UrologyInfertility: Therapy1 Apr 20131888 SUCCESSFUL TESTICULAR SPERM RETRIEVAL IN KLINEFELTER ADOLESCENTS TREATED WITH AT LEAST ONE YEAR OF TOPICAL TESTOSTERONE AND AROMATASE INHIBITOR Akanksha Mehta, Alexander Bolyakov, Jordan Roosma, Peter Schlegel, and Darius Paduch Akanksha MehtaAkanksha Mehta New York, NY More articles by this author , Alexander BolyakovAlexander Bolyakov New York, NY More articles by this author , Jordan RoosmaJordan Roosma New York, NY More articles by this author , Peter SchlegelPeter Schlegel New York, NY More articles by this author , and Darius PaduchDarius Paduch New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2307AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testosterone replacement therapy (TRT) is advocated in adolescents with Klinefelter syndrome (KS) to promote linear growth, increase muscle mass, preserve bone density, and allow for the development of secondary sexual characteristics. However, the impact of TRT on the fertility potential of KS adolescents is unknown. The aim of this study was to evaluate surgical sperm retrieval rates in KS adolescents on TRT at a specialized academic center. METHODS All subjects were azoospermic, with cytogenetic evaluation confirming a non-mosaic 47,XXY karyotype. All subjects were treated with a combination of topical testosterone (T) and aromatase inhibitor (anastrozole 1 mg). Two centrifuged semen samples (3000g × 30 min) were examined for each patient. Microsurgical testicular sperm extraction (TESE) was performed after confirming azoospermia. All consecutive TESE procedures performed between 1/1/12 and 9/31/12 were analyzed. Demographic data, baseline and preoperative serum T, FSH, and LH levels, dose and duration of TRT, testicular volumes, testicular histology patterns, and TESE outcomes were collected for each patient. Each TESE specimen was analyzed by two embryologists. RESULTS Nine subjects underwent TESE. Patient age ranged from 14-22 yrs (mean 15.6). Baseline serum T, LH, and FSH levels ranged from 40-350 ng/dL (mean 188), 0.6-25.1 mIU/mL (mean 9.4), and 1.37-25.1 mIU/mL (mean 20.4), respectively. Mean testicular volume was 3.9 cm3. On TRT, pre-op serum T, LH, and FSH levels ranged from 126-990 ng/dL (mean 690), 4.76-46.2 mIU/mL (mean 16), and 4.68-74.5 mIU/mL (mean 35.4), respectively. Duration of TRT prior to sperm retrieval varied between one and five years. Sperm were successfully retrieved in 7/9 patients (78%). With the exception of one patient, in whom only rare, non-motile sperm were identified, mean sperm concentration ranged from 0.1 to 2 x106/mL, with a total sperm count between 0.01 and 2 x106. No post-operative complications occurred. Testicular volume, age or duration of TRT did not predict sperm retrieval. CONCLUSIONS Testicular sperm was extracted and cryopreserved in 7/9 (78%) of KS adolescents treated with topical TRT and oral aromatase inhibitors for a period of one to five years. Use of topical TRT did not appear to suppress spermatogenesis. It is uncertain whether sperm retrieval rates would be higher or lower without testosterone replacement in these young males. Sperm cryopreservation should be discussed in all KS adolescents who are either receiving or considering initiating TRT. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e774 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akanksha Mehta New York, NY More articles by this author Alexander Bolyakov New York, NY More articles by this author Jordan Roosma New York, NY More articles by this author Peter Schlegel New York, NY More articles by this author Darius Paduch New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...