Fertility and sterility · 2025
Surgical sperm retrieval in patients with nonmosaic Klinefelter syndrome (47,XXY) may be safely delayed until adulthood: a systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Momtazi-Mar Leila, Naelitz Bryan D, Mucci Andrea, Cannarella Rossella, Lundy Scott D
Аннотация
IMPORTANCE: Klinefelter syndrome (KS) is the most common genetic cause of azoospermia and results in germ cell apoptosis, seminiferous tubule hyalinization, and testicular interstitial hyperplasia. It remains controversial whether surgical sperm retrieval should be performed soon after puberty or may be safely delayed until adulthood.
OBJECTIVE: To assess the relationship between age and surgical sperm retrieval success in patients with nonmosaic KS, with particular attention to outcomes in adolescence versus adulthood.
DATA SOURCES: PubMed, Embase, and Medline queried through 1/15/2025.
STUDY SELECTION AND SYNTHESIS: Studies were included if they reported outcomes from conventional or microdissection testicular sperm extraction in patients with nonmosaic (47,XXY) KS. Extracted data included age and number of participants, sperm retrieval rate (SRR), live birth rate (LBR), total testicular volume, preprocedural testosterone, blood follicle-stimulating hormone, and luteinizing hormone levels.
MAIN OUTCOMES: SRR with testicular sperm extraction.
RESULTS: Forty eight studies were included with a total of 2,815 participants and a median SRR of 44%. Sensitivity analyses determined a low risk of bias. Nine studies or subgroups of studies analyzed adolescent participants with a mean age <20 years. Of 48 studies, 24 reported findings for groups of patients with positive sperm retrieval compared to negative sperm retrieval. Meta-analysis estimated that groups with positive sperm retrieval were on average 2.8 years younger than groups with negative sperm retrieval (95% confidence interval: -3.62 to -2.02 years; I2 = 78%). There was no difference in the mean SRR between adolescent and adult cohorts (45% vs. 42%) across all studies. There was a nonsignificant quadratic relationship between age and SRR, potentially suggesting that sperm retrieval outcomes may decline after 40 years of age. Twenty-two studies reported LBRs with an overall median of 11.1%.
CONCLUSION AND RELEVANCE: Sperm retrieval success in men with nonmosaic KS is similar between adolescence and reproductive adulthood but may potentially decrease with advanced paternal age >40 years. Although overall LBR remains modest because of compounded attrition associated with sperm retrieval and assisted reproduction, patients can be reassured that delaying sperm retrieval until mid-adulthood will not significantly alter their ability to achieve biological parenthood.
OBJECTIVE: To assess the relationship between age and surgical sperm retrieval success in patients with nonmosaic KS, with particular attention to outcomes in adolescence versus adulthood.
DATA SOURCES: PubMed, Embase, and Medline queried through 1/15/2025.
STUDY SELECTION AND SYNTHESIS: Studies were included if they reported outcomes from conventional or microdissection testicular sperm extraction in patients with nonmosaic (47,XXY) KS. Extracted data included age and number of participants, sperm retrieval rate (SRR), live birth rate (LBR), total testicular volume, preprocedural testosterone, blood follicle-stimulating hormone, and luteinizing hormone levels.
MAIN OUTCOMES: SRR with testicular sperm extraction.
RESULTS: Forty eight studies were included with a total of 2,815 participants and a median SRR of 44%. Sensitivity analyses determined a low risk of bias. Nine studies or subgroups of studies analyzed adolescent participants with a mean age <20 years. Of 48 studies, 24 reported findings for groups of patients with positive sperm retrieval compared to negative sperm retrieval. Meta-analysis estimated that groups with positive sperm retrieval were on average 2.8 years younger than groups with negative sperm retrieval (95% confidence interval: -3.62 to -2.02 years; I2 = 78%). There was no difference in the mean SRR between adolescent and adult cohorts (45% vs. 42%) across all studies. There was a nonsignificant quadratic relationship between age and SRR, potentially suggesting that sperm retrieval outcomes may decline after 40 years of age. Twenty-two studies reported LBRs with an overall median of 11.1%.
CONCLUSION AND RELEVANCE: Sperm retrieval success in men with nonmosaic KS is similar between adolescence and reproductive adulthood but may potentially decrease with advanced paternal age >40 years. Although overall LBR remains modest because of compounded attrition associated with sperm retrieval and assisted reproduction, patients can be reassured that delaying sperm retrieval until mid-adulthood will not significantly alter their ability to achieve biological parenthood.