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Elzeiny H, Agresta F, Stevens J, Gardner DK. A rare case of mosaic Klinefelter syndrome in a 45-year-old man leading to successful live birth through ejaculated spermatozoa: a case report and literature review. Front Genet 2023; 14:1242180. [PMID: 37779907 PMCID: PMC10533916 DOI: 10.3389/fgene.2023.1242180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background: Men diagnosed with Klinefelter syndrome (KS) commonly exhibit non-obstructive azoospermia or rarely having sperm in their ejaculate, rendering them traditionally considered sterile prior to the introduction of intracytoplasmic sperm injection (ICSI). The presence of mosaic KS may mask the classical phenotype, resulting in underdiagnosis throughout their lifetime. Surgical sperm retrieval through Microdissection Testicular Sperm Extraction (Micro-TESE) combined with ICSI has become the gold standard approach, maximizing reproductive outcomes in these individuals. However, it is noteworthy that approximately 7% of men with KS may exhibit sperm in their ejaculate, providing an opportunity for them to achieve biological parenthood through ICSI. Case Presentation: In this report, we present an exceptional case of a 45-year-old man with Mosaic KS and severe oligozoospermia who successfully achieved pregnancy utilizing ICSI with freshly ejaculated sperm. Remarkably, this case represents the oldest recorded instance of a man with Klinefelter syndrome fathering his own biological child using sperm derived from fresh ejaculate. Conclusion: Although this case is exceedingly rare, it underscores the critical importance of exhausting all possibilities to facilitate biological parenthood in men with KS before considering alternative options such as sperm donation or adoption. By recognizing the potential for successful conception using ejaculated sperm in this population, we can provide individuals with mosaic KS the opportunity to fulfill their desire for biological offspring.
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Affiliation(s)
- Hossam Elzeiny
- Melbourne IVF, Melbourne, VIC, Australia
- Royal Women’s Hospital, Melbourne, VIC, Australia
| | | | | | - David K. Gardner
- Melbourne IVF, Melbourne, VIC, Australia
- School of Bioscience, University of Melbourne, Parkville, VIC, Australia
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Xu WQ, Yuan Y, Chen Y, Luo T, Chen HY. Birth of a boy after intracytoplasmic sperm injection using ejaculated spermatozoa from a nonmosaic klinefelter syndrome man with normal sperm motility: A case report. Front Genet 2022; 13:989701. [PMID: 36212158 PMCID: PMC9538340 DOI: 10.3389/fgene.2022.989701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Klinefelter syndrome (KS) is the most common sex chromosome abnormality, which occurs in about one in 660 newly born males, and it is the most common genetic cause of infertility in infertile men, accounting for 11%. It is rare for non-mosaic KS patients to have sperm and reproduce naturally, and there are currently no reports of KS patients with normal motile sperm. Microdissection testicular sperm extraction associated with intracytoplasmic sperm injection (micro-TESE-ICSI) is currently the main assisted reproductive method for patients with KS. In this study, we describe a patient of non-mosaic KS (47, XXY) who had given birth to a healthy girl naturally. The patient had normal male characteristics and did not have the symptoms of hypogonadism commonly seen in KS. He had high levels of serum follicle stimulating hormone and luteinizing hormone, a low level of serum testosterone, and a normal level of prolactin. Semen analysis showed that this case had normal motile sperm (total motility of 57.66% and progressive motility of 46.19%) but low sperm concentration (1.7 × 106 cells/mL). He gave birth to a boy by intracytoplasmic sperm injection (ICSI) using his ejaculated sperm purified to high density and motility by Percoll density gradient centrifugation. In conclusion, this case is a unique non-mosaic KS patient who had a normal sperm motility, experienced a natural fertility, and received a successful ICSI outcome, which enlarges our knowledges on non-mosaic KS.
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Affiliation(s)
- Wen-qing Xu
- Institute of Life Science and School of Life Science, Nanchang University, Nanchang, China
| | - Yuan Yuan
- Institute of Life Science and School of Life Science, Nanchang University, Nanchang, China
| | - Ying Chen
- Institute of Life Science and School of Life Science, Nanchang University, Nanchang, China
- Key Laboratory of Reproductive Physiology and Pathology in Jiangxi Province, Nanchang, China
| | - Tao Luo
- Institute of Life Science and School of Life Science, Nanchang University, Nanchang, China
- Key Laboratory of Reproductive Physiology and Pathology in Jiangxi Province, Nanchang, China
- *Correspondence: Tao Luo, Hou-yang Chen,
| | - Hou-yang Chen
- Key Laboratory of Reproductive Physiology and Pathology in Jiangxi Province, Nanchang, China
- Reproductive Medical Center, Jiangxi Maternal and Child Health Hospital, Affiliated Maternal and Child Health Hospital of Nanchang University, Nanchang, China
- *Correspondence: Tao Luo, Hou-yang Chen,
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Chu KY, Ory J, Punjani N, Nassau DE, Israeli J, Kashanian JA, Ramasamy R. Utility of evaluating semen samples from adolescents with Klinefelter Syndrome for cryopreservation: A multi-institution evaluation. J Pediatr Urol 2022; 18:288.e1-288.e5. [PMID: 35491303 DOI: 10.1016/j.jpurol.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Klinefelter Syndrome (KS) is the most common genetic condition cause of non-obstructive azoospermia (NOA). KS also often results in decreased testicular growth and testosterone production. Because of this, exogenous testosterone therapy is commonly prescribed for KS patients to treat hypogonadism, but this may have additional impacts to future fertility potential. KS adolescent patients may be asked to provide multiple semen samples to identify potential sperm for early cryopreservation. OBJECTIVE To develop a multi-institutional database to evaluate the prevalence of sperm in the ejaculate of adolescent KS patients. METHODS A retrospective study was performed of all adolescent KS patients seen at two high-volume tertiary male infertility clinics between 2015 and 2020. Adolescence was defined as individuals aged 12-19 years, as per the World Health Organization. Demographic information data including weight, height, medical comorbidities, and concurrent medications were collected. Serum hormone levels including FSH, LH, and testosterone were collected, as well as any available semen analysis data. RESULTS A total of 116 patients were identified and included in the database. A total of 100 (86.2%) had hormone data available and 48 (41.3%) had semen analysis data. Of the 48 patients with semen analyses, only 4 (8.3%) patients had rare sperm in the ejaculate while the remaining had azoospermia (91.7%). None of the specimens were suitable for cryopreservation. The average serum total testosterone level of adolescent KS patients was 181 ± 216 ng/dL. FSH levels were 14.3 ± 18.8 IU/L (normal 0.3-10.0 IU/L) and LH levels were 7.8 ± 12.4 IU/L (normal 1.2-7.8 IU/L). A total of 17 patients repeated a semen analysis, and in no instance did this result in sperm where there was none previously. CONCLUSION The findings from a large multicenter retrospective cohort of adolescent KS patients suggest that a single semen analysis is sufficient for attempted cryopreservation purposes, and that multiple semen analyses is not needed.
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Affiliation(s)
- Kevin Y Chu
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Jesse Ory
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA; Department of Urology, Dalhousie University, Halifax NS, Canada
| | - Nahid Punjani
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel E Nassau
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Joseph Israeli
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
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Dwyer AA, Héritier V, Llahana S, Edelman L, Papadakis GE, Vaucher L, Pitteloud N, Hauschild M. Navigating Disrupted Puberty: Development and Evaluation of a Mobile-Health Transition Passport for Klinefelter Syndrome. Front Endocrinol (Lausanne) 2022; 13:909830. [PMID: 35813640 PMCID: PMC9264386 DOI: 10.3389/fendo.2022.909830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Klinefelter syndrome (KS) is the most common aneuploidy in men and has long-term sequelae on health and wellbeing. KS is a chronic, lifelong condition and adolescents/young adults (AYAs) with KS face challenges in transitioning from pediatric to adult-oriented services. Discontinuity of care contributes to poor outcomes for health and wellbeing and transition programs for KS are lacking. We aimed to develop and test a mobile health tool (KS Transition Passport) to educate patients about KS, encourage self-management and support successful transition to adult-oriented care. First, we conducted a retrospective chart review and patient survey to examine KS transition at a university hospital. Second, we conducted a systematic scoping review of the literature on AYAs with KS. Last, we developed a mobile health transition passport and evaluated it with patient support groups. Participants evaluated the tool using the System Usability Scale and Patient Education Materials Assessment Tool (PEMAT). Chart review identified 21 AYAs diagnosed between 3.9-16.8 years-old (median 10.2 years). The survey revealed only 4/10 (40%) were on testosterone therapy and fewer (3/10, 30%) had regular medical care. The scoping review identified 21 relevant articles highlighting key aspects of care for AYAs with KS. An interprofessional team developed the mobile-health KS transition passport using an iterative process. Support group members (n=35) rated passport usability as 'ok' to 'good' (70 ± 20, median 73.5/100). Of PEMAT dimensions, 5/6 were deemed 'high quality' (86-90/100) and participants knew what to do with the information (actionability = 83/100). In conclusion, many patients with KS appear to have gaps in transition to adult-oriented care. Iterative development of a KS transition passport produced a mobile health tool that was usable, understandable and had high ratings for actionability.
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Affiliation(s)
- Andrew A. Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
- Endocrinology, Diabetes & Metabolism Service of the Department of Medicine, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Vanessa Héritier
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department of Women-Mother-Child, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Sofia Llahana
- School of Health and Psychological Sciences, City University of London, London, United Kingdom
| | - Lauren Edelman
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Georgios E. Papadakis
- Endocrinology, Diabetes & Metabolism Service of the Department of Medicine, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Laurent Vaucher
- Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Nelly Pitteloud
- Endocrinology, Diabetes & Metabolism Service of the Department of Medicine, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Michael Hauschild
- Pediatric Endocrinology, Diabetes and Obesity Unit, Department of Women-Mother-Child, Lausanne University Hospital Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- *Correspondence: Michael Hauschild,
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Kailash Y, Raheem AA, Homa ST. How Successful Is Surgical Sperm Retrieval in Klinefelter Syndrome? FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:636629. [DOI: 10.3389/frph.2021.636629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Klinefelter Syndrome (KS) is characterized by the presence of an extra X chromosome. It was first diagnosed in 1942 in a group of azoospermic men. KS is the most common chromosomal abnormality encountered in infertile men and accounts for more than 10% of the causes of azoospermia. Men who are azoospermic may still father children via testicular sperm extraction followed by intracytoplasmic sperm injection (ICSI). This review article summarizes the success rates of the available techniques for surgical sperm retrieval (SSR) in KS including conventional testicular sperm extraction (cTESE) and micro testicular sperm extraction (mTESE), as well as the risks of these procedures for future fertility. The evidence indicates that the SSR rate is as successful in non-mosaic men with KS as those with normal karyotypes, with retrieval rates of up to 55% reported. The influence of different factors that affect the chances of a successful outcome are discussed. In particular, the impact of aneuploidy rate, physical characteristics, co-morbidities, reproductive endocrine balance and the use of different hormone management therapies are highlighted. Evidence is presented to suggest that the single most significant determinant for successful SSR is the age of the patient. The success of SSR is also influenced by surgical technique and operative time, as well as the skills of the surgeon and embryology team. Rescue mTESE may be used successfully following failed TESE in KS patients in combination with hormone stimulation.
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A clinical algorithm for management of fertility in adolescents with the Klinefelter syndrome. Curr Opin Urol 2020; 30:324-327. [DOI: 10.1097/mou.0000000000000757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ben Rhouma M, Okutman O, Muller J, Benkhalifa M, Bahri H, Ben Rhouma K, Tebourbi O, Viville S. [Genetic aspects of male infertility: From bench to clinic]. ACTA ACUST UNITED AC 2018; 47:54-62. [PMID: 30514637 DOI: 10.1016/j.gofs.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of our manuscript is to review the current state of research on the genetics of male infertility, highlighting the genetic abnormalities that can lead to non-syndromic male infertility and genetic testing proposed to patients. It is intended primarily for clinicians and biologists of reproductive medicine. METHODS A comprehensive review of the scientific literature available on PubMed was conducted using keywords related to male infertility and genetics. Since the first genes related to non-syndromic male infertility were identified after the 2000s, bibliographic research was conducted after this date. RESULTS Thirty-three genes have been identified as responsible for non-syndromic male infertility. The evolution of techniques based on whole genome analysis has allowed the development of more successful methods in the identification of new genes and mutations inducing an infertility phenotype. Through this article, we propose, by concrete examples, a clinical approach for genetic tests considering the semen analysis alterations. CONCLUSIONS The identification and characterization of these genes and the mutations responsible for certain infertility phenotypes allow better management and better treatment for patients as well as a better understanding of the physiopathological mechanisms of human gametogenesis.
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Affiliation(s)
- M Ben Rhouma
- Institut de parasitologie et pathologie tropicale, EA 7292, fédération de médecine translationelle, université de Strasbourg, 3, rue Koeberlé, 67000 Strasbourg, France; Laboratoire de physiologie intégrée, UR11S33, faculté des sciences de Bizerte, université de Carthage, 7021 Jarzouna-Bizerte, Tunisie; Laboratoire de diagnostic génétique, UF3472-génétique de l'infertilité, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - O Okutman
- Institut de parasitologie et pathologie tropicale, EA 7292, fédération de médecine translationelle, université de Strasbourg, 3, rue Koeberlé, 67000 Strasbourg, France; Laboratoire de diagnostic génétique, UF3472-génétique de l'infertilité, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - J Muller
- Laboratoire de diagnostic génétique, UF3472-génétique de l'infertilité, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - M Benkhalifa
- Médecine de la reproduction et cytogénétique médicale, CHU et faculté de médecine, université de Picardie Jules-Verne, 80000, Amiens, France
| | - H Bahri
- Alyssa Fertility Group, Clinique Alyssa, rue du lac Léman 1053, Les Berges du Lac, Tunis, Tunisie
| | - K Ben Rhouma
- Laboratoire de physiologie intégrée, UR11S33, faculté des sciences de Bizerte, université de Carthage, 7021 Jarzouna-Bizerte, Tunisie
| | - O Tebourbi
- Laboratoire de physiologie intégrée, UR11S33, faculté des sciences de Bizerte, université de Carthage, 7021 Jarzouna-Bizerte, Tunisie
| | - S Viville
- Institut de parasitologie et pathologie tropicale, EA 7292, fédération de médecine translationelle, université de Strasbourg, 3, rue Koeberlé, 67000 Strasbourg, France; Laboratoire de diagnostic génétique, UF3472-génétique de l'infertilité, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
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Genetic evaluation of patients with non-syndromic male infertility. J Assist Reprod Genet 2018; 35:1939-1951. [PMID: 30259277 DOI: 10.1007/s10815-018-1301-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/28/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE This review provides an update on the genetics of male infertility with emphasis on the current state of research, the genetic disorders that can lead to non-syndromic male infertility, and the genetic tests available for patients. METHODS A comprehensive review of the scientific literature referenced in PubMed was conducted using keywords related to male infertility and genetics. The search included articles with English abstracts appearing online after 2000. RESULTS Mutations in 31 distinct genes have been identified as a cause of non-syndromic human male infertility, and the number is increasing constantly. Screening gene panels by high-throughput sequencing can be offered to patients in order to identify genes involved in various forms of human non-syndromic infertility. We propose a workflow for genetic tests which takes into account semen alterations. CONCLUSIONS The identification and characterization of the genetic basis of male infertility have broad implications not only for understanding the cause of infertility but also in determining the prognosis, selection of treatment options, and management of couples. Genetic diagnosis is essential for the success of ART techniques and for preserving future fertility as well as the prognosis for testicular sperm extraction (TESE) and adopted therapeutics.
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Shah R, Gupta C. Advances in sperm retrieval techniques in azoospermic men: A systematic review. Arab J Urol 2018; 16:125-131. [PMID: 29713543 PMCID: PMC5922005 DOI: 10.1016/j.aju.2017.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/15/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate various methods of operative sperm retrieval in men with non-obstructive azoospermia (NOA) and to determine the optimal surgical approach in terms of effectiveness, morbidity, and complications. MATERIALS AND METHODS PubMed and Cochrane databases were searched to identify five recent reviews and meta-analyses evaluating outcomes for sperm retrieval in men with NOA. RESULTS AND CONCLUSION Micro-TESE is the most efficient method for retrieving sperm but requires special expertise and can be traumatic for the testes. Conventional biopsies are twice more likely to retrieve sperm than fine-needle aspiration. Testicular aspiration performed by multiple passes into the testis is traumatic and is not efficient for sperm retrieval. Needle-aspiration biopsy and open real-time testicular mapping by the single seminiferous tubule technique can offer less traumatic methods for sperm retrieval, which can be tried before proceeding to micro-TESE. The first attempt at sperm retrieval is the best chance the patient has and should combine various techniques sequentially to give the highest chance of success with the least morbidity.
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Key Words
- (N)OA, (non-)obstructive azoospermia
- (O)FNA, (open) fine-needle aspiration
- (c) (micro-) (n) TESE, (conventional) (microdissection) (needle) testicular sperm extraction
- AZF(a)(b)(c), azoospermia factor (a) (b) (c)
- ICSI, intracytoplasmic sperm injection
- IVF, in vitro fertilisation
- MeSH, medical subject heading
- NAB, needle aspiration biopsy;
- Non-obstructive azoospermia
- Operative sperm retrieval
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis
- SRR, sperm retrieval rate
- SSSSR, single-session staged sperm retrieval
- SST, single seminiferous tubule
- TESA, testicular sperm aspiration
- Testicular failure
- Testicular sperm extraction
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Affiliation(s)
- Rupin Shah
- Lilavati Hospital and Research Centre, Bandra Reclamation, Bandra west, Mumbai, India
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Abstract
Microdissection testicular sperm extraction (microTESE) is considered the gold standard method for surgical sperm retrieval among patients with non-obstructive azoospermia (NOA). In this review, we will discuss the optimal evaluation of NOA patients and strategies to medically optimize NOA patients prior to microTESE. In addition, we will also discuss technical principles and pearls to maximize the chances of successful sperm retrieval, sperm retrieval rates (SRR) based upon testicular histology, predictors of successful sperm retrieval, gonadal recovery following microTESE, and potential complications.
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Davis S, Howell S, Wilson R, Tanda T, Ross J, Zeitler P, Tartaglia N. Advances in the Interdisciplinary Care of Children with Klinefelter Syndrome. Adv Pediatr 2016; 63:15-46. [PMID: 27426894 PMCID: PMC5340500 DOI: 10.1016/j.yapd.2016.04.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Shanlee Davis
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Department of Endocrinology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B265, Aurora, CO 80045, USA
| | - Susan Howell
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B140, Aurora, CO 80045, USA
| | - Rebecca Wilson
- Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B140, Aurora, CO 80045, USA
| | - Tanea Tanda
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B140, Aurora, CO 80045, USA
| | - Judy Ross
- Department of Pediatrics, Thomas Jefferson University School of Medicine, 833 Chestnut Street, Philadelphia, PA 19107, USA; Pediatric Endocrinology, Nemours A.I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Philip Zeitler
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Department of Endocrinology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B265, Aurora, CO 80045, USA
| | - Nicole Tartaglia
- Department of Pediatrics, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA; Developmental Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue B140, Aurora, CO 80045, USA.
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Davis SM, Rogol AD, Ross JL. Testis Development and Fertility Potential in Boys with Klinefelter Syndrome. Endocrinol Metab Clin North Am 2015; 44:843-65. [PMID: 26568497 PMCID: PMC4648691 DOI: 10.1016/j.ecl.2015.07.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Klinefelter syndrome (KS) is the leading genetic cause of primary hypogonadism and infertility in men. The clinical phenotype has expanded beyond the original description of infertility, small testes, and gynecomastia. Animal models, epidemiologic studies, and clinical research of male subjects with KS throughout the lifespan have allowed the better characterization of the variable phenotype of this condition. This review provides an overview on what is known of the epidemiology, clinical features, and pathophysiology of KS, followed by a more focused discussion of testicular development and the clinical management of hypogonadism and fertility in boys and men with KS.
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Affiliation(s)
- Shanlee M. Davis
- University of Colorado/Children’s Hospital Colorado, 13123 East 16 Ave B264, Aurora, CO 80045, 720-777-6073
| | - Alan D. Rogol
- University of Virginia, 685 Explorers Road, Charlottesville, VA 22911, 434-971-6687, Consultant to: SOV Therapeutics, Trimel Pharmaceuticals, NovoNordisk, Versartis, AbbVie
| | - Judith L. Ross
- Department of Pediatric Endocrinology A.I. DuPont Hospital for Children/ Thomas Jefferson University, Department of Pediatrics, 833 Chestnut St., Philadelphia, Pennsylvania, 19107
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Bernard V, Bouvattier C, Christin-Maitre S. [Therapeutic issues concerning male fertility]. ANNALES D'ENDOCRINOLOGIE 2015; 75 Suppl 1:S13-20. [PMID: 25617918 DOI: 10.1016/s0003-4266(14)70023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Men reproductive health has long been ignored although it is responsible for 50% of couple's infertility. However, in recent years, the understanding of endocrine physiology underlying testis development and spermatogenesis has enabled the development of new therapeutic strategies. Some concern the management of male infertility. Others are dealing with finding an effective male contraceptive. In this review, we first present the management of infertility, in patients with congenital hypogonadotropic hypogonadism. We then describe the major improvements for Klinefelter patient's infertility. Finally, we review the different hormonal and non-hormonal methods for male contraception, currently in development. Efficacy and safety of the some non-hormonal methods remain to be demonstrated so far in humans.
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Affiliation(s)
- V Bernard
- Unité INSERM 693, 63 rue Gabriel-Péri, 94276 Le Kremlin-Bicêtre cedex, France.
| | - C Bouvattier
- Service d'endocrinologie et diabétologie pédiatrique, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - S Christin-Maitre
- Service d'endocrinologie et maladies de la reproduction, Hôpital Saint-Antoine, Paris, France
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Tachon G, Lefort G, Puechberty J, Schneider A, Jeandel C, Boulot P, Prodhomme O, Meyer P, Taviaux S, Touitou I, Pellestor F, Geneviève D, Gatinois V. Discordant sex in monozygotic XXY/XX twins: a case report. Hum Reprod 2014; 29:2814-20. [PMID: 25336706 DOI: 10.1093/humrep/deu275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We report a case of discordant phenotypic sex in monozygotic twins mosaic 47,XXY/46,XX: monozygotic heterokaryotypic twins. The twins presented with cognitive and comprehension delay, behavioural and language disorders, all symptoms frequently reported in Klinefelter syndrome. Molecular zygosity analysis with several markers confirmed that the twins are in effect monozygotic (MZ). Array comparative genomic hybridization found no evidence for the implication of copy number variation in the phenotypes. Ultrasound scans of the reproductive organs revealed no abnormalities. Endocrine tests showed a low testosterone level in Twin 1 (male phenotype) and a low gonadotrophin level in Twin 2 (female phenotype) which, combined with the results from ultrasound examination, provided useful information for potentially predicting the future fertility potential of the twins. Blood karyotypes revealed the presence of a normal 46,XX cell line and an aneuploïd 47,XXY cell line in both patients. Examination of the chromosome constitutions of various tissues such as blood, buccal smear and urinary sediment not surprisingly showed different proportions for the 46,XX and 47,XXY cell lines, which most likely explains the discordant phenotypic sex and mild Klinefelter features. The most plausible underlying biological mechanism is a post-zygotic loss of the Y chromosome in an initially 47,XXY zygote. This would result in an embryo with both 46,XX and 47,XXY cells lines which could subsequently divide into two monozygotic embryos through a twinning process. The two cell lines would then be distributed differently between tissues which could result in phenotypic discordances in the twins. These observations emphasize the importance of regular paediatric evaluations to determine the optimal timing for fertility preservation measures and to detect new Klinefelter features which could appear throughout childhood in the two subjects.
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Affiliation(s)
- G Tachon
- Département de Génétique Médicale, CHRU Montpellier, Faculté de Médecine Université Montpellier 1, Montpellier, France Laboratoire de Génétique Chromosomique, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - G Lefort
- Laboratoire de Génétique Chromosomique, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - J Puechberty
- Département de Génétique Médicale, CHRU Montpellier, Faculté de Médecine Université Montpellier 1, Montpellier, France
| | - A Schneider
- Laboratoire de Génétique Chromosomique, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - C Jeandel
- Endocrinologie Pédiatrique, Hôpital Lapeyronie, CHRU Montpellier, Montpellier, France
| | - P Boulot
- Service de Gynécologie Obstétrique, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - O Prodhomme
- Service de Radiopédiatrie, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - P Meyer
- Service de Neuropédiatrie, Hôpital Gui-de-Chauliac, CHRU Montpellier, INSERM U1046, Université Montpellier 1-2, Montpellier, France
| | - S Taviaux
- Laboratoire de Génétique Chromosomique, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - I Touitou
- Unité Médicale des Maladies Auto-inflammatoire, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - F Pellestor
- Laboratoire de Génétique Chromosomique, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | - D Geneviève
- Département de Génétique Médicale, CHRU Montpellier, Faculté de Médecine Université Montpellier 1, Montpellier, France
| | - V Gatinois
- Laboratoire de Génétique Chromosomique, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
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