Aging may adversely affect testicular sperm recovery in patients with Klinefelter syndrome

Objectives. To investigate the clinical parameters or laboratory analyses that may have a predictive value for successful sperm retrieval in Klinefelter syndrome (KS). Methods. A total of 74 patients with nonmosaic KS were included in this study. All patients were azoospermic and underwent microdissection testicular sperm extraction for sperm recovery. The predictive values of patient age, testicular volume, serum follicle-stimulating hormone, luteinizing hormone, and testosterone levels were assessed for successful sperm recovery. Results. Testicular sperm recovery was successful in 42 (56.7%) of 74 men. The serum follicle-stimulating hormone, luteinizing hormone, and total testosterone levels did not show any difference between the patients with successful and those with unsuccessful sperm recovery. However, the patients with successful sperm recovery were significantly younger (31.6 +/- 4.3 years) than those with failed attempts (35 +/- 5.1 years, P = 0.002). In the receiver operating characteristics curve analysis, a cutoff of 30.5 years of age had a sensitivity of 78% and a specificity of 48% for successful sperm retrieval. Logistic regression analysis showed that sperm recovery was inversely related to patient age (odds ratio 0.854, 95% confidence interval 0.76 to 0.95). Conclusions. Microdissection testicular sperm extraction is an effective sperm recovery technique in patients with KS. Our data have demonstrated that aging might adversely affect the sperm recovery rate in men with KS. These results suggest that earlier infertility assessment and testicular sperm extraction in men with KS might play a critical role in their treatment.