Successful testicular sperm retrieval in adolescents with Klinefelter syndrome treated with at least 1 year of topical testosterone and aromatase inhibitor

Capsule:
Sperm retrieval and cryopreservation is possible in adolescents with Klinefelter syndrome who are actively being treated with topical testosterone replacement therapy.

Authors:
Akanksha Mehta, M.D., Alexander Bolyakov, M.Sc., Jordan Roosma, Peter N. Schlegel, M.D., Ph.D., Darius A. Paduch, M.D., Ph.D.

Volume 100, Issue 4, Pages 970-974, October 2013

Abstract:

Objective:
To evaluate surgical sperm retrieval rates in adolescents with Klinefelter syndrome and testosterone replacement therapy (TRT).

Design:
Case series.

Setting:
Academic medical center.

Patient(s):
Ten patients with Klinefelter syndrome, aged 14–22 years, treated with testosterone replacement and aromatase inhibitor therapy for a period of 1–5 years before surgical sperm retrieval.

Intervention(s):
Microsurgical testis sperm extraction with cryopreservation of harvested tissue.

Main Outcome Measure(s):
Presence of spermatozoa within testis tissue.

Result(s):
Successful sperm retrieval in 7/10 patients (70%).

Conclusion(s):
Use of topical TRT did not appear to suppress spermatogenesis in adolescents with KS. 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.

  • Interesting and well written article.

    Several questions arose for the authors after I read this:

    1. Can anyone explain if anastrazole or any other aromatase inhibitor has a protective effect on spermatogenesis while someone is on exogeneous testosterone?

    2. Given the young average age of the study cohort, could spermatogenesis be preserved also in part due to the earlier attempts at sperm extraction and cryoperservation prior to progression of testicular hyalinization found in KS men?

    3. Can this treatment regimen be extrapolated to obese men with symptomatic low testosterone who are being treated with exogenous testosterone that have a significant rise in estradiol levels resulting in symptoms despite normalization of testosterone levels? Can we safely treat these men with anastrazole long term as well to decrease the E2 levels?

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