Clinical comparison of successful and failed microdissection testicular sperm extraction in patients with nonmosaic Klinefelter syndrome.

OBJECTIVES: Testicular sperm extraction (TESE), together with intracytoplasmic sperm injection, has become the treatment of choice for patients with nonobstructive azoospermia related to nonmosaic Klinefelter syndrome (KS) who want to father children. However, predicting successful microdissection TESE for patients with KS remains controversial. Thus, we conducted a study to determine whether the prediction of successful microdissection TESE is possible in patients with nonmosaic KS.

METHODS: The subjects were 26 men with nonmosaic KS who had undergone microdissection TESE. The patients were divided into two groups: those in whom the procedure was successful and those in whom it was not. Several factors, including patient age, testicular volume, endocrinologic data, and intraoperative morphologic appearance of the testes were compared between the two groups.

RESULTS: Testicular spermatozoa were retrieved successfully in 13 (50%) of the 26 patients. None of the factors investigated differed significantly between the two groups according to the Mann-Whitney U test or multivariate logistic regression analysis. Testicular spermatozoa were successfully retrieved from 16 (94.1%) of the 17 testes in which the seminiferous tubules without sclerotic changes were observed but were not found in any of the 29 testes without seminiferous tubules (P <0.0001).

CONCLUSIONS: For patients with nonmosaic KS, it is encouraging that testicular sperm were successfully identified in 50% of our patients. Although we did not find any factor predictive of successful testicular sperm retrieval by microdissection TESE, the outcome of microdissection TESE for patients with nonmosaic KS appears to depend on the identification of seminiferous tubules without sclerotic changes in the testicular tissue.