Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China.
Institute of Bioscience and Biotechnology, Yangzhou University, Yangzhou, 225009, China.
J Assist Reprod Genet. 2020 Sep;37(9):2053-2079. doi: 10.1007/s10815-020-01818-2. Epub 2020 Jun 20.
Patients with Klinefelter syndrome (KS) who receive assisted reproductive technology (ART) treatment often experience poor pregnancy rates due to decreased fertilization, cleavage, and implantation rates and even an increased miscarriage rate. Mounting evidence from recent studies has shown that various technological advances and approaches could facilitate the success of ART treatment for KS patients. In this review, we summarize the methods for guiding KS patients during ART and for developing optimal strategies for preserving fertility, improving pregnancy rate and live birth rate, and avoiding the birth of KS infants.
We searched PubMed and Google Scholar publications related to KS patients on topics of controlled ovarian stimulation protocols, sperm extraction, fertility preservation, gamete artificial activation, round spermatid injection (ROSI), and non-invasive prenatal screening (PGD) methods.
This review outlines the different ovulation-inducing treatments for female partners according to the individual sperm status in the KS patient. We further summarize the methods of retrieving sperm, storing, and freezing rare sperm. We reviewed different methods of gamete artificial activation and discussed the feasibility of ROSI for sterile KS patients who absolutely lack sperm. The activation of eggs in the process of intracytoplasmic sperm injection and non-invasive PGD are urgently needed to prevent the birth of KS infants.
The integrated strategies will pave the way for the establishment of ART treatment approaches and improve the clinical outcome for KS patients.
克氏综合征（KS）患者接受辅助生殖技术（ART）治疗时，常因受精率、卵裂率和着床率降低，甚至流产率增加而导致妊娠率不佳。最近的研究证据表明，各种技术进步和方法可以促进 KS 患者 ART 治疗的成功。在这篇综述中，我们总结了指导 KS 患者进行 ART 的方法，以及制定最佳策略以保留生育能力、提高妊娠率和活产率并避免 KS 婴儿出生的方法。
我们检索了 PubMed 和 Google Scholar 上与 KS 患者相关的 ART 主题的出版物，包括控制性卵巢刺激方案、精子提取、生育力保存、配子人工激活、圆形精子注射（ROSI）和非侵入性产前筛查（PGD）方法。
本综述概述了根据 KS 患者个体精子状况，为女性伴侣选择不同的促排卵治疗方法。我们进一步总结了精子提取、储存和冷冻的方法。我们回顾了不同的配子人工激活方法，并讨论了对于绝对缺乏精子的不育 KS 患者进行 ROSI 的可行性。卵胞浆内单精子注射过程中卵子的激活和非侵入性 PGD 迫切需要防止 KS 婴儿的出生。
综合策略将为建立 ART 治疗方法铺平道路，并改善 KS 患者的临床结局。
