Spermatogonial stem cell preservation in Klinefelter boys: to bank or not to bank, that’s the question

Capsule:
To date, retrieval of spermatogonial cells in prepubertal boys with Klinefelter syndrome should be viewed as experimental and patients and their parents must be counseled accordingly.

Authors:
Inge Gies, M.D., Jean De Schepper, M.D., Ph.D., Ellen Goossens, Ph.D., Dorien Van Saen, M.Sc., Guido Pennings, Ph.D., Herman Tournaye, M.D., Ph.D.

Volume 98, Issue 2, Pages 284-289, August 2012

Abstract:
Although early development of testis appears normal in boys with Klinefelter syndrome (KS), spermatogonial stem cell (SSC) depletion occurs in mid puberty, leading to infertility. Therefore, freezing of semen samples or testicular tissue sampling could be offered to KS boys at onset of puberty. However, only in about half of KS patients, adult or prepubertal, spermatozoa or SSCs can be observed, and to date, no clinical parameters are available to detect patients who might benefit from these techniques. Furthermore, strategies for the further use of the cryopreserved material are still under investigation. Retrieval of spermatogonial cells in prepubertal KS boys should therefore still be viewed as experimental and patients and their parents must be counseled accordingly.

  • Mike Hsieh

    Interesting timely review. With emerging research showing the capability of in vitro support of embryonic stem cell differentiation into germ cell. There really is not a downside to early intervention of KS patients. If we are offering tissue cryopreservation to pediatric oncology patients, KS boys should not be excluded.

  • Pravin Rao

    This is an exciting field and a great review. As stated, it is important to be very objective when counseling patients/families about the pros and cons of early versus late retrieval since the pros and cons are yet to be determined.

    It would be interesting to find out what fraction of andrology labs themselves are comfortable with the technical aspects of tissue cryopreservation and are actively offering these services. Readers — are you and/or your labs offering this option to boys with KS?

  • Paul Shin

    I would echo dr hwang’s sentiments. The current trend of counseling KS boys at an earlier age and intervening is a good one. Although retrieval rates remain favorably high for KS induced non obstructive azoospermia, if an earlier less invasive intervention could yield as good or better an outcome that’s a win-win.

  • khwang

    Excellent and thorough article. I believe the authors very nicely address a real challenge. The current available options for adult KS patients yield ~50% sperm retrieval rate with Micro TESE, and the unknown of whether preserving pre-pubertal tissue could potentially yield higher rates once the technology and techniques are available for these patients in the future renders this still experimental making appropriate counseling imperative.

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