Evaluation of Predicting Factors Affecting Sperm Retrieval in Patients with Klinefelter Syndrome: A Prospective Study

Document Type : Original Article


1 Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Anatomy, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran

3 Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran

4 Department of Urology, Shariati Hosital, Tehran University of Medical Sciences, Tehran, Iran

5 Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran


Background: This study aimed to evaluate the predicting factors affecting sperm retrieval. We prospectively assessed
the relationship between sonographic and microdissection testicular sperm extraction (mTESE) findings in Klinefelter
syndrome (KS).
Materials and Methods: In this prospective study, 44 azoospermic men with 47, XXY karyotypes participated in this
study. In order to evaluate the amount of blood supply in different parts of testicular tissue, a doppler ultra-sonographic
was performed. Also, for the detection of sperm in this group mTESE technique was performed.
Results: The age average of positive mTESE and negative mTESE groups was 29.4 and 33.6 years, respectively. By
comparing the testicle volume (based on the data obtained from the clinical examinations conducted by the urologist)
it was determined that there is no significant difference between mTESE positive and negative groups. Folliclestimulating
hormone (FSH) levels in men with negative mTESE (P=0.03) and testosterone levels in men with positive
mTESE significantly increased (P=0.017). The overall rate of testis vascularity was significantly higher in the positive
mTESE group than in the negative mTESE group. The clinical pregnancy rate in positive mTESE men was 9% per
cycle, 16.6% per embryos were transferred (ET), and 12.5% per cycle.
Conclusion: Totally, our observation indicated that there is not a significant relationship between sonographic and mTESE
results in KS patients. However, more investigations with bigger sample Size can be useful to validate our results.


Main Subjects


    1. Durairajanayagam D. Lifestyle causes of male infertility. Arab J Urol. 2018; 16(1): 10-20.
    2. Miyamoto T, Minase G, Shin T, Ueda H, Okada H, Sengoku K. Human male infertility and its genetic causes. Reprod Med Biol. 2017; 16(2): 81-88.
    3. Babakhanzadeh E, Nazari M, Ghasemifar S, Khodadadian A. Some of the factors involved in male infertility: a prospective review. Int J Gen Med. 2020; 13: 29-41.
    4. Aliakbari F, Taghizabet N, Azizi F, Rezaei-Tazangi F, Gelehkolaee KS, Kharazinejad E. A review of methods for preserving male fertility. Zygote. 2022; 30(3): 289-97.
    5. Corona G, Pizzocaro A, Lanfranco F, Garolla A, Pelliccione F, Vignozzi L, et al. Sperm recovery and ICSI outcomes in Klinefelter syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2017; 23(3): 265-275.
    6. Samango-Sprouse CA, Counts DR, Tran SL, Lasutschinkow PC, Porter GF, Gropman AL. Update on the clinical perspectives and care of the child with 47,XXY (klinefelter syndrome). Appl Clin Genet. 2019; 12: 191-202.
    7. Samango-Sprouse C, Lasutschinkow P, Powell S, Sadeghin T, Gropman A. The incidence of anxiety symptoms in boys with 47,XXY (Klinefelter syndrome) and the possible impact of timing of diagnosis and hormonal replacement therapy. Am J Med Genet A. 2019; 179(3): 423-428
    8. Nariyoshi S, Nakano K, Sukegawa G, Sho T, Tsuji Y. Ultrasonographically determined size of seminiferous tubules predicts sperm retrieval by microdissection testicular sperm extraction in men with nonobstructive azoospermia. Fertil Steril. 2020; 113(1): 97-104. e2.
    9. Altinkilic B, Pilatz A, Diemer T, Wolf J, Bergmann M, Schönbrunn S, et al. Prospective evaluation of scrotal ultrasound and intratesticular perfusion by color-coded duplex sonography (CCDS) in TESE patients with azoospermia. World J Urol. 2018; 36(1): 125-133.
    10. Ekerhovd E, Westlander G. Testicular sonography in men with Klinefelter syndrome shows irregular echogenicity and blood flow of high resistance. J Assist Reprod Genet. 2002; 19(11): 517-522
    11. Rocher L, Moya L, Correas JM, Mutuon P, Ferlicot S, Young J, et al. Testis ultrasound in Klinefelter syndrome infertile men: making the diagnosis and avoiding inappropriate management. Abdom Radiol (NY). 2016; 41(8): 1596-1603.
    12. Franco G, Scarselli F, Casciani V, De Nunzio C, Dente D, Leonardo C, et al. A novel stepwise micro-TESE approach in non obstructive azoospermia. BMC Urol. 2016; 16(1): 20.
    13. Emre Bakircioglu M, Erden HF, Kaplancan T, Ciray N, Bener F, Bahceci M. Aging may adversely affect testicular sperm recovery in patients with Klinefelter syndrome. Urology. 2006; 68(5): 1082-1086.
    14. Okada H, Goda K, Yamamoto Y, Sofikitis N, Miyagawa I, Mio Y, et al. Age as a limiting factor for successful sperm retrieval in patients with nonmosaic Klinefelter's syndrome. Fertil Steril. 2005; 84(6): 1662-1664.
    15. Pavan-Jukic D, Starc A, Stubljar D, Jukic T. Obesity with high body mass index does not influence sperm retrieval in males with azoospermia. Med Sci Monit. 2020; 26: e923060.
    16. Kort HI, Massey JB, Elsner CW, Mitchell-Leef D, Shapiro DB, Witt MA, Roudebush WE. Impact of body mass index values on sperm quantity and quality. J Androl. 2006; 27(3): 450-452.
    17. Taha EA, Abd El-Wahed SR, Mostafa T. Relation of color doppler parameters with testicular size in oligoasthenoteratozoospermic men with a varicocele. Hum Androl. 2012; 2(1): 6-11.
    18. Schill T, Bals-Pratsch M, Küpker W, Sandmann J, Johannisson R, Diedrich K. Clinical and endocrine follow-up of patients after testicular sperm extraction. Fertil Steril. 2003; 79(2): 281-286.
    19. Har-Toov J, Eytan O, Hauser R, Yavetz H, Elad D, Jaffa AJ. A new power doppler ultrasound guiding technique for improved testicular sperm extraction. Fertil Steril. 2004; 81(2): 430-434.