Ramasamy Ranjith, Ricci Joseph A, Palermo Gianpiero D, Gosden Lucinda Veeck, Rosenwaks Zev, Schlegel Peter N
Center for Reproductive Medicine and Infertility, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
J Urol. 2009 Sep;182(3):1108-13. doi: 10.1016/j.juro.2009.05.019. Epub 2009 Jul 18.
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.
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.
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.
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.
我们研究了可预测无精子症和非嵌合型克兰费尔特综合征男性患者显微切割睾丸取精成功的术前因素。我们还分析了术前激素治疗对精子获取率的影响。
对68例非嵌合型克兰费尔特综合征男性患者共进行了91次显微切割睾丸取精尝试。血清睾酮低于300 ng/dl的男性在显微切割睾丸取精前接受芳香化酶抑制剂、克罗米芬或人绒毛膜促性腺激素治疗。比较手术成功和未成功患者的术前患者年龄和内分泌数据等因素。精子获取率是主要观察指标。还计算了临床妊娠（有心跳的妊娠）和活产率。
45例男性（66%）成功获取睾丸精子，占62次尝试（68%）。男性年龄增加与精子获取率降低趋势相关（p = 0.05）。各种术前激素治疗的精子获取率无差异，但基线睾酮正常的男性精子获取率最高，为86%。需要药物治疗且治疗后睾酮达到250 ng/dl或更高的患者，其精子获取率高于治疗后睾酮低于250 ng/dl的患者（77%对55%）。对于获取精子的体外受精尝试，临床妊娠率和活产率分别为57%和45%。
显微切割睾丸取精是克兰费尔特综合征男性有效的精子获取技术。对药物治疗有反应的性腺功能减退男性可能有更好的精子获取机会。
