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The Klinefelter Syndrome and Testicular Sperm Retrieval Outcomes. Genes (Basel) 2023; 14:genes14030647. [PMID: 36980920 PMCID: PMC10048758 DOI: 10.3390/genes14030647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Klinefelter syndrome (KS), caused by the presence of an extra X chromosome, is the most prevalent chromosomal sexual anomaly, with an estimated incidence of 1:500/1000 per male live birth (karyotype 47,XXY). High stature, tiny testicles, small penis, gynecomastia, feminine body proportions and hair, visceral obesity, and testicular failure are all symptoms of KS. Endocrine (osteoporosis, obesity, diabetes), musculoskeletal, cardiovascular, autoimmune disorders, cancer, neurocognitive disabilities, and infertility are also outcomes of KS. Causal theories are discussed in addition to hormonal characteristics and testicular histology. The retrieval of spermatozoa from the testicles for subsequent use in assisted reproduction treatments is discussed in the final sections. Despite testicular atrophy, reproductive treatments allow excellent results, with rates of 40–60% of spermatozoa recovery, 60% of clinical pregnancy, and 50% of newborns. This is followed by a review on the predictive factors for successful sperm retrieval. The risks of passing on the genetic defect to children are also discussed. Although the risk is low (0.63%) when compared to the general population (0.5–1%), patients should be informed about embryo selection through pre-implantation genetic testing (avoids clinical termination of pregnancy). Finally, readers are directed to a number of reviews where they can enhance their understanding of comprehensive diagnosis, clinical care, and fertility preservation.
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Renault L, Labrune E, Giscard d’Estaing S, Cuzin B, Lapoirie M, Benchaib M, Lornage J, Soignon G, de Souza A, Dijoud F, Fraison E, Pral-Chatillon L, Bordes A, Sanlaville D, Schluth–Bolard C, Salle B, Ecochard R, Lejeune H, Plotton I. Delaying testicular sperm extraction in 47,XXY Klinefelter patients does not impair the sperm retrieval rate, and AMH levels are higher when TESE is positive. Hum Reprod 2022; 37:2518-2531. [PMID: 36112034 PMCID: PMC9627253 DOI: 10.1093/humrep/deac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Should testicular sperm extraction (TESE) in non-mosaic 47,XXY Klinefelter syndrome (KS) patients be performed soon after puberty or could it be delayed until adulthood? SUMMARY ANSWER The difference in sperm retrieval rate (SRR) in TESE was not significant between the 'Young' (15-22 years old) cohort and the 'Adult' (23-43 years old) cohort of non-mosaic KS patients recruited prospectively in parallel. WHAT IS KNOWN ALREADY Several studies have tried to define predictive factors for TESE outcome in non-mosaic KS patients, with very heterogeneous results. Some authors have found that age was a pejorative factor and recommended performing TESE soon after puberty. To date, no predictive factors have been unanimously recognized to guide clinicians in deciding to perform TESE in azoospermic KS patients. STUDY DESIGN, SIZE, DURATION Two cohorts (Young: 15-22 years old; Adult: 23-43 years old) were included prospectively in parallel. A total of 157 non-mosaic 47,XXY KS patients were included between 2010 and 2020 in the reproductive medicine department of the University Hospital of Lyon, France. However 31 patients gave up before TESE, four had cryptozoospermia and three did not have a valid hormone assessment; these were excluded from this study. PARTICIPANTS/MATERIALS, SETTING, METHODS Data for 119 patients (61 Young and 58 Adult) were analyzed. All of these patients had clinical, hormonal and seminal evaluation before conventional TESE (c-TESE). MAIN RESULTS AND THE ROLE OF CHANCE The global SRR was 45.4%. SRRs were not significantly different between the two age groups: Young SRR=49.2%, Adult SRR = 41.4%; P = 0.393. Anti-Müllerian hormone (AMH) and inhibin B were significantly higher in the Young group (AMH: P = 0.001, Inhibin B: P < 0.001), and also higher in patients with a positive TESE than in those with a negative TESE (AMH: P = 0.001, Inhibin B: P = 0.036). The other factors did not differ between age groups or according to TESE outcome. AMH had a better predictive value than inhibin B. SRRs were significantly higher in the upper quartile of AMH plasma levels than in the lower quartile (or in cases with AMH plasma level below the quantification limit): 67.7% versus 28.9% in the whole population (P = 0.001), 60% versus 20% in the Young group (P = 0.025) and 71.4% versus 33.3% in the Adult group (P = 0.018). LIMITATIONS, REASONS FOR CAUTION c-TESE was performed in the whole study; we cannot rule out the possibility of different results if microsurgical TESE had been performed. Because of the limited sensitivity of inhibin B and AMH assays, a large number of patients had values lower than the quantification limits, preventing the definition a threshold below which negative TESE can be predicted. WIDER IMPLICATIONS OF THE FINDINGS In contrast to some studies, age did not appear as a pejorative factor when comparing patients 15-22 and 23-44 years of age. Improved accuracy of inhibin B and AMH assays in the future might still allow discrimination of patients with persistent foci of spermatogenesis and guide clinician decision-making and patient information. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by a grant from the French Ministry of Health D50621 (Programme Hospitalier de Recherche Clinical Régional 2008). The authors have no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER NCT01918280.
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Affiliation(s)
- Lucie Renault
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
| | - Elsa Labrune
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
| | - Sandrine Giscard d’Estaing
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
| | - Beatrice Cuzin
- Service d’Urologie et de Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marion Lapoirie
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Mehdi Benchaib
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Jacqueline Lornage
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
| | - Gaëlle Soignon
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - André de Souza
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Frédérique Dijoud
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
- Laboratoire d’Anatomopathologie, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Bron, France
| | - Eloïse Fraison
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
| | - Laurence Pral-Chatillon
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Agnès Bordes
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Damien Sanlaville
- Université Claude Bernard Lyon 1, Lyon, France
- Service de Génétique, Laboratoire de Cytogénétique Constitutionnelle, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
- Lyon Neuroscience Research Center, GENDEV Team, CNRS UMR 5292, INSERM U1028, UCBL1, Bron, France
| | - Caroline Schluth–Bolard
- Université Claude Bernard Lyon 1, Lyon, France
- Service de Génétique, Laboratoire de Cytogénétique Constitutionnelle, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
- Lyon Neuroscience Research Center, GENDEV Team, CNRS UMR 5292, INSERM U1028, UCBL1, Bron, France
| | - Bruno Salle
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
| | - René Ecochard
- Université Claude Bernard Lyon 1, Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Hervé Lejeune
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
| | - Ingrid Plotton
- Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Université Claude Bernard Lyon 1, Lyon, France
- Inserm U1208, Bron Cedex, France
- Service de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France
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Kızılay F, Altay B, Aşçı R, Çayan S, Ekmekçioğlu O, Yaman Ö, Kadıoğlu A. Retrospective analysis of factors affecting sperm retrieval with microscopic testicular sperm extraction in infertile men with Klinefelter syndrome: A multicentre study. Andrologia 2022; 54:e14379. [PMID: 35102587 DOI: 10.1111/and.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to evaluate the data currently available on predictors of sperm retrieval (SR) in infertile men with Klinefelter syndrome (KS). The data of infertile patients with KS who were evaluated for primary infertility in the andrology outpatient clinics of six centres were retrospectively reviewed. SR, fertilization and pregnancy rates were evaluated. While SR was achieved with microscopic testicular sperm extraction (mTESE) in 57.7% of the cases, the positive pregnancy rate was 22%. While mosaicism was significantly associated with achieving pregnancy, it was not significant for SR (p = 0.002 and p = 0.136 respectively). However, receiving medical treatment prior to mTESE was a positive factor for both achieving pregnancy (p = 0.010) and successful SR (p = 0.032). Unsurprisingly, fertilization rate was a variable that increased the pregnancy rate (p = 0.001). In addition, total testosterone value correlated with SR (p < 0.001). For patients with KS, pregnancy can be achieved by obtaining sperm through mTESE, especially in those with mosaic karyotype, normal partner fertility, a high fertilization rate and who receive appropriate medical treatment before mTESE.
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Affiliation(s)
- Fuat Kızılay
- Faculty of Medicine, Department of Urology, Ege University, Izmir, Turkey
| | - Barış Altay
- Faculty of Medicine, Department of Urology, Ege University, Izmir, Turkey
| | - Ramazan Aşçı
- Faculty of Medicine, Department of Urology, Ondokuz Mayıs University, Samsun, Turkey
| | - Selahittin Çayan
- Faculty of Medicine, Department of Urology, Mersin University, Mersin, Turkey
| | - Oğuz Ekmekçioğlu
- Faculty of Medicine, Department of Urology, Erciyes University, Kayseri, Turkey
| | - Önder Yaman
- Faculty of Medicine, Department of Urology, Ankara University, Ankara, Turkey
| | - Ateş Kadıoğlu
- Istanbul Faculty of Medicine, Department of Urology, Istanbul University, Istanbul, Turkey
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Lan Y, Zheng H, Fu X, Peng T, Liao C, Liu J, Liu M, An G. Clinical Outcomes and Live Birth Rate Resulted From Microdissection Testicular Sperm Extraction With ICSI-IVF in Non-Obstructive Azoospermia: A Single-Center Cohort Study. Front Endocrinol (Lausanne) 2022; 13:893679. [PMID: 35813616 PMCID: PMC9259991 DOI: 10.3389/fendo.2022.893679] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most of data available in the literature reported the sperm retrieval rate and limited intracytoplasmic sperm injection (ICSI) results of microdissection testicular sperm extraction (micro-TESE) in non-obstructive azoospermia (NOA) patients with different etiologies. Unfortunately, there is currently a lack of comprehensive data to guide clinicians in conducting comprehensive consultations with NOA patients. OBJECTIVES To obtain more comprehensive evidence-based data and clinical outcomes for better consultation of NOA patients who opted to undergo micro-TESE combined with ICSI-IVF. METHODS It was a retrospective study involved 968 NOA patients underwent micro-TESE during January 2015 to December 2019. Embryological, clinical, and live birth outcomes were demonstrated comprehensively and three kinds of stratification analyses were performed based on ICSI-IVF cycles using frozen and fresh sperm, different etiologies of NOA and various amounts of sperm retrieved. RESULTS The sperm retrieval rate was 44.6%, and ICSI was performed in 299 couples leading to 150 clinical pregnancies and 140 live-birth deliveries. The clinical pregnancy rate (CPR) was 50.17%, and the cumulative live birth rate (LBR) was 46.82%, and the low birth defects rate was 1.43%. No significant difference was observed about cumulative LBR in frozen sperm group and fresh sperm group (47.5% vs 42.9%, P>0.05). NOA patients with AZFc microdeletions had the lowest rate of a high-score embryo on day 3 (4.4%, P<0.05) and the lowest cumulative LBR (19.4%, P<0.05). NOA patients with lower sperm count (having fewer than 20 sperms retrieved) had significantly lower cumulative LBR than those with higher sperm count (having more than 20 sperms retrieved) (28.1% vs 51.9%, P<0.05). CONCLUSIONS For those NOA patients who stepped in ICSI-IVF cycles, the cumulative LBR was 46.82%. No significant difference was indicated in the LBR between ICSI-IVF cycles using frozen or fresh testicular sperm. Compared to other etiologies, NOA caused by AZFc microdeletions have the poorest embryological and clinical outcomes. Patients with less testicular sperm retrieved have poorer embryological and clinical outcomes.
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Affiliation(s)
- Yu Lan
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haiyan Zheng
- Center for Reproductive Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Fu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tianwen Peng
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chen Liao
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianan Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Liu
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Geng An
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Geng An,
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Jellad S, Arfaoui R, Souayah N, Hammami F. Successful live birth after intracytoplasmic sperm injection using testicular sperm in non-mosaic Klinefelter syndrome. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2022. [DOI: 10.4103/2305-0500.335862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Majzoub A, Arafa M, Clemens H, Imperial J, Leisegang K, Khalafalla K, Agarwal A, Henkel R, Elbardisi H. A systemic review and meta-analysis exploring the predictors of sperm retrieval in patients with non-obstructive azoospermia and chromosomal abnormalities. Andrologia 2021; 54:e14303. [PMID: 34729809 DOI: 10.1111/and.14303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 01/10/2023] Open
Abstract
To identify the most prevalent chromosomal abnormalities in patients with non-obstructive azoospermia (NOA), consolidate their surgical sperm retrieval (SSR) rates and determine the significant predictors of positive SSR in this patient population. A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fifty-three studies including 2965 patients were identified through searching the PubMed database. Klinefelter Syndrome (KS) was the most prevalent chromosomal abnormality reported in 2239 cases (75.5%). Azoospermia factor c (AZFc) microdeletions were the second most common (18.6%), but men with these deletions had higher SSR rates than patients with KS (41.95% with AZFc vs. 38.63% with KS). When examining predictors of SSR in KS patients, younger age was a significant predictor of positive SSR in patients undergoing microsurgical testicular sperm extraction (micro-TESE). Higher testosterone was a favourable predictor in those undergoing micro-TESE and conventional TESE. Lower luteinizing hormone (LH) and follicular stimulating hormone (FSH) values were significantly associated with positive SSR with testicular sperm aspiration (TESA). No parameter predicted SSR rates in patients with AZFc microdeletions. Overall, genetic abnormalities have significant implications on SSR success in patients with NOA.
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Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Andrology Department, Cairo University, Cairo, Egypt
| | - Hailey Clemens
- Department of Molecular and Developmental Biology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Jacqueline Imperial
- Department of Biology, University of California San Francisco, San Francisco, California, USA
| | - Kris Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | | | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Metabolism, Digestion and Reproduction at, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.,LogixX Pharma, Theale, Berkshire, UK
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Amer M, Fakhry E. Fresh vs frozen testicular sperm for assisted reproductive technology in patients with non-obstructive azoospermia: A systematic review. Arab J Urol 2021; 19:247-254. [PMID: 34552776 PMCID: PMC8451649 DOI: 10.1080/2090598x.2021.1932303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective : To review the debate about the routine use of cryopreserved testicular sperm for intracytoplasmic sperm injection (ICSI) from patients with non-obstructive azoospermia (NOA), as some authors suggest repeating sperm retrieval in such cases due to poorer ICSI results when frozen–thawed testicular sperm is used compared with fresh sperm. Methods : A systematic literature review was performed in August 2020 using the Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science databases and the Excerpta Medica dataBASE (EMBASE), and we included 26 studies that were considered eligible for this systematic review. Results : In all, 1189 publications were screened and 26 articles were included in the systematic review. Three meta-analysis reviews were included and they all concluded that the use of fresh and frozen sperms for ICSI from patients with NOA showed comparable fertilisation and pregnancy rates. Conclusion : The use of frozen testicular sperm from men with NOA results in fertilisation and clinical pregnancy rates similar to those of fresh sperm. This may encourage fertility centres to use frozen testicular sperm samples, as this policy has certain advantages that would help with organising their workflow. Abbreviations: CPR: clinical pregnancy rate; 2PN%: two pronuclei % fertilisation rate; ICSI: intracytoplasmic sperm injection; NOA: non-obstructive azoospermia; OA, obstructive azoospermia; SCO: Sertoli cell-only syndrome; (micro-)TESE: (microsurgical) testicular sperm extraction
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Affiliation(s)
- Medhat Amer
- Departments of Andrology and IVF Laboratory, Adam International Hospital, Giza, Egypt.,Department of Andrology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad Fakhry
- Departments of Andrology and IVF Laboratory, Adam International Hospital, Giza, Egypt
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Ignatieva EV, Osadchuk AV, Kleshchev MA, Bogomolov AG, Osadchuk LV. A Catalog of Human Genes Associated With Pathozoospermia and Functional Characteristics of These Genes. Front Genet 2021; 12:662770. [PMID: 34290736 PMCID: PMC8287579 DOI: 10.3389/fgene.2021.662770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
Genetic causes of the global decline in male fertility are among the hot spots of scientific research in reproductive genetics. The most common way to evaluate male fertility in clinical trials is to determine semen quality. Lower semen quality is very often accompanied by subfertility or infertility, occurs in many diseases and can be caused by many factors, including genetic ones. The following forms of lowered semen quality (pathozoospermia) are known: azoospermia, oligozoospermia, asthenozoospermia, teratozoospermia, and some combined forms. To systematize information about the genetic basis of impaired spermatogenesis, we created a catalog of human genes associated with lowered semen quality (HGAPat) and analyzed their functional characteristics. The catalog comprises data on 126 human genes. Each entry of the catalog describes an association between an allelic variant of the gene and a particular form of lowered semen quality, extracted from the experimental study. Most genes included into the catalog are located on autosomes and are associated with such pathologies as non-obstructive azoospermia, oligozoospermia or asthenozoospermia. Slightly less than half of the included genes (43%) are expressed in the testes in a tissue-specific manner. Functional annotation of genes from the catalog showed that spermatogenic failure can be associated with mutations in genes that control biological processes essential for spermiogenesis (regulating DNA metabolism, cell division, formation of cellular structures, which provide cell movement) as well as with mutations in genes that control cellular responses to unfavorable conditions (stress factors, including oxidative stress and exposure to toxins).
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Affiliation(s)
- Elena V Ignatieva
- The Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia.,Department of Natural Science, Novosibirsk State University, Novosibirsk, Russia
| | - Alexander V Osadchuk
- The Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Maxim A Kleshchev
- The Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Anton G Bogomolov
- The Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Ludmila V Osadchuk
- The Federal Research Center Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
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Aydos K, Aydos OS. Sperm Selection Procedures for Optimizing the Outcome of ICSI in Patients with NOA. J Clin Med 2021; 10:jcm10122687. [PMID: 34207121 PMCID: PMC8234729 DOI: 10.3390/jcm10122687] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 12/19/2022] Open
Abstract
Retrieving spermatozoa from the testicles has been a great hope for patients with non-obstructive azoospermia (NOA), but relevant methods have not yet been developed to the level necessary to provide resolutions for all cases of NOA. Although performing testicular sperm extraction under microscopic magnification has increased sperm retrieval rates, in vitro selection and processing of quality sperm plays an essential role in the success of in vitro fertilization. Moreover, sperm cryopreservation is widely used in assisted reproductive technologies, whether for therapeutic purposes or for future fertility preservation. In recent years, there have been new developments using advanced technologies to freeze and preserve even very small numbers of sperm for which conventional techniques are inadequate. The present review provides an up-to-date summary of current strategies for maximizing sperm recovery from surgically obtained testicular samples and, as an extension, optimization of in vitro sperm processing techniques in the management of NOA.
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Affiliation(s)
- Kaan Aydos
- Department of Urology, Reproductive Health Research Center, School of Medicine, University of Ankara, 06230 Ankara, Turkey
- Correspondence: ; Tel.: +90-533-748-8995
| | - Oya Sena Aydos
- Department of Medical Biology, School of Medicine, University of Ankara, 06230 Ankara, Turkey;
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YURCİ A, DOKUZEYLÜL GÜNGÖR N. Use of frozen-thawed sperm for ICSI improves fertility outcome in men with azoospermia. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.895843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Oraiopoulou C, Vorniotaki A, Taki E, Papatheodorou A, Christoforidis N, Chatziparasidou A. The impact of fresh and frozen testicular tissue quality on embryological and clinical outcomes. Andrologia 2021; 53:e14040. [PMID: 33682176 DOI: 10.1111/and.14040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/11/2021] [Accepted: 02/21/2021] [Indexed: 12/01/2022] Open
Abstract
Our ability to predict the potential of testicular spermatozoa to support embryonic development is still limited. Although motility of testicular spermatozoa is associated with embryo development, the impact of morphology and the presence of spermatozoa in the testicular sample has not been previously researched. Moreover, while the majority of data indicate no effect of cryopreservation, there are studies reporting impaired clinical outcomes due to testicular cryopreservation. In a retrospective study, 118 ICSI-TESE cycles were analysed to study the impact of (a) total quality of testicular tissue, (b) testicular tissue cryopreservation and (c) presence/motility/morphology of testicular spermatozoa in fertilisation rate, embryonic development, clinical pregnancy (CPR), ongoing pregnancy (OPR) and live birth rate (LBR). Results showed that fertilisation rate was significantly affected by both total quality of testicular tissue (p < .05) and rare presence of spermatozoa (p < .01). Moreover, total tissue quality (p < .01), cryopreservation of low-quality samples (p < .01), absence of motile testicular spermatozoa (p < .01) and poor spermatozoa morphology (p < .05) had a negative impact on the number of good quality day 3 embryos. CPR, OPR or LBR was not affected by any parameters examined. Our data suggest that the quality of testicular tissue influences both fertilisation rate and embryo development. Moreover, cryopreservation of low-quality testicular samples has a negative impact on the number of available embryos for transfer.
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Affiliation(s)
| | | | - Eleni Taki
- Embryolab Fertility Clinic, Thessaloniki, Greece
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Vorontsova MV, Kalinchenko NY. [Klinefelter syndrome: literature review on using modern methods of assisted reproductive technologies]. ACTA ACUST UNITED AC 2020; 66:31-38. [PMID: 33481365 DOI: 10.14341/probl12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/06/2020] [Accepted: 11/29/2020] [Indexed: 11/06/2022]
Abstract
The article reviews scientific papers devoted to the problem of reproductive health in men with Klinefelter syndrome (KS). Pathogenesis from a very early age (in utero), the possibility of ensuring biological paternity upon reaching sexual maturity and the risk of chromosomal abnormalities in offspring are discussed. Despite the fact that KS is one of the most common causes of male infertility associated with chromosomal abnormalities, due to the variability of clinical manifestations the proportion of patients identified before puberty did not exceed 10% before the widespread introduction of non-invasive prenatal testing. According to the research results presented in the article, the reproductive potential of males with KS is often already reduced in early childhood. These circumstances should be considered when choosing further patient management tactics.There are few reports on the onset of spontaneous pregnancy in the case of KS, so ensuring biological paternity in this group of patients is often possible only using surgical methods of sperm extraction and assisted reproductive technologies. This article discusses methods like testicular sperm extraction (TESE) and microdissection testicular sperm extraction (mTESE) in terms of their effectiveness and safety for the patient, and the factors influencing the outcome of the operation. The optimal period of these manipulations seems to be the patient's age from 18 to 30 years, although the feasibility of adolescent boys undergoing the aforementioned procedures is highly controversial.The research papers presented in the article suggest that the risk of transmitting chromosomal abnormalities to offspring is rather low, which does not exclude the need for medical and genetic counseling to explain all possible risks to the patient. Preimplantation or intrauterine diagnostics are also deemed necessary.
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Deebel NA, Bradshaw AW, Sadri-Ardekani H. Infertility considerations in klinefelter syndrome: From origin to management. Best Pract Res Clin Endocrinol Metab 2020; 34:101480. [PMID: 33358481 DOI: 10.1016/j.beem.2020.101480] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Klinefelter syndrome (KS) is defined as the presence of one or more extra "X" chromosome in a male patient. It affects approximately 1 in 600 newborn males and the most common chromosomal abnormality, leading to male hypogonadism and infertility. There is a lack of data supporting best practices for KS patients' care. In this paper we review controversial issues in KS research ranging from mechanisms of variation in KS phenotype to abnormalities resulting in reduced sperm production to successful sperm retrieval disparities after testicular sperm extraction (TESE). Translation to live birth and offspring health is also examined. Finally, medical therapies used to optimize the hormonal status and chances of fertility in KS patients are reviewed. We will also discuss the experimental spermatogonial stem cell (SSC) treatments, which are considered the future for TESE negative patients.
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Affiliation(s)
- Nicholas A Deebel
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Aaron W Bradshaw
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hooman Sadri-Ardekani
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
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15
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Chen W, Bai MZ, Yang Y, Sun D, Wu S, Sun J, Wu Y, Feng Y, Wei Y, Chen Z, Zhang Z. ART strategies in Klinefelter syndrome. J Assist Reprod Genet 2020; 37:2053-2079. [PMID: 32562095 DOI: 10.1007/s10815-020-01818-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/10/2020] [Indexed: 01/31/2023] Open
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION The integrated strategies will pave the way for the establishment of ART treatment approaches and improve the clinical outcome for KS patients.
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Affiliation(s)
- Wei Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Ming Zhu Bai
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Yixia Yang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Di Sun
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Sufang Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Jian Sun
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Yu Wu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Youji Feng
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Youheng Wei
- Institute of Bioscience and Biotechnology, Yangzhou University, Yangzhou, 225009, China
| | - Zijiang Chen
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Zhenbo Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, 200080, China.
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16
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Arshad MA, Majzoub A, Esteves SC. Predictors of surgical sperm retrieval in non-obstructive azoospermia: summary of current literature. Int Urol Nephrol 2020; 52:2015-2038. [PMID: 32519242 DOI: 10.1007/s11255-020-02529-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 12/20/2022]
Abstract
Intracytoplasmic sperm injection (ICSI), combined with surgical sperm retrieval (SR) techniques, is the sole option for patients with non-obstructive azoospermia to achieve fertility; however, with suboptimal results. Given the variability in clinical presentation, the potential role of factors that can predict the likelihood of successful testicular SR needs to be clarified. This article summarizes the current evidence concerning the variables predicting SR success in non-obstructive azoospermic patients with spermatogenic failure. For this, we used 60 articles, including 46 original papers and six meta-analyses. Clinical and laboratory factors, as well as adjuvant therapies and surgical retrieval methods, were the factors most commonly investigated. We found that Klinefelter syndrome, Y chromosome microdeletions in regions AZFa/b, and Sertoli cell-only histopathology were associated with reduced SR success. By contrast, testis volume > 12.5 ml, history of cryptorchidism, use of micro-TESE as the sperm retrieval method, and adjuvant therapy were associated with improved SR success. None of the predictors, alone or combined, provide definitive information about the chances of harvesting sperm in men with non-obstructive azoospermia, except for Y chromosome microdeletions in regions AZFa/b. In the latter, SR success is virtually nil. We conclude that SR outcomes in men with non-obstructive azoospermia are difficult to predict based on the existing variables. Although several predictors can be used for patient counseling, their clinical value is limited to either ensure SR success or discourage reproductive urologists from recommending SR to men with non-obstructive azoospermia seeking fertility. A notable exception includes the deletions involving the regions AZFa and/or AZFb of the Y chromosome; the affected patients should be counseled against undergoing SR.
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Affiliation(s)
- Muhammad A Arshad
- Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
- Nishter Hospital, Multan, Pakistan
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine- Qatar, Doha, Qatar
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, 1464, Campinas, São Paulo, 13075-460, Brazil.
- Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil.
- Faculty of Health, Department of Clinical Sciences, Aarhus University, Aarhus, Denmark.
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17
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Tartaglia N, Howell S, Davis S, Kowal K, Tanda T, Brown M, Boada C, Alston A, Crawford L, Thompson T, van Rijn S, Wilson R, Janusz J, Ross J. Early neurodevelopmental and medical profile in children with sex chromosome trisomies: Background for the prospective eXtraordinarY babies study to identify early risk factors and targets for intervention. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:428-443. [PMID: 32506668 DOI: 10.1002/ajmg.c.31807] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 01/03/2023]
Abstract
Sex chromosome trisomies (SCT), including Klinefelter syndrome/XXY, Trisomy X, and XYY syndrome, occur in 1 of every 500 births. The past decades of research have resulted in a broadening of known associated medical comorbidities as well as advances in psychological research. This review summarizes what is known about early neurodevelopmental, behavioral, and medical manifestations in young children with SCT. We focus on recent research and unanswered questions related to the risk for neurodevelopmental disorders that commonly present in the first years of life and discuss the medical and endocrine manifestations of SCT at this young age. The increasing rate of prenatal SCT diagnoses provides the opportunity to address gaps in the existing literature in a new birth cohort, leading to development of the eXtraordinarY Babies Study. This study aims to better describe and compare the natural history of SCT conditions, identify predictors of positive and negative outcomes in SCT, evaluate developmental and autism screening measures commonly used in primary care practices for the SCT population, and build a rich data set linked to a bank of biological samples for future study. Results from this study and ongoing international research efforts will inform evidence-based care and improve health and neurodevelopmental outcomes.
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Affiliation(s)
- Nicole Tartaglia
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Susan Howell
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Shanlee Davis
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Pediatric Endocrinology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Karen Kowal
- Department of Pediatric Endocrinology, Nemours-Dupont Hospital for Children, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tanea Tanda
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Mariah Brown
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA.,Pediatric Endocrinology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Cristina Boada
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Amanda Alston
- Department of Pediatric Endocrinology, Nemours-Dupont Hospital for Children, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leah Crawford
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Talia Thompson
- Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Sophie van Rijn
- Clinical Neurodevelopment Sciences, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
| | - Rebecca Wilson
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Developmental Pediatrics, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Jennifer Janusz
- eXtraordinarY Kids Clinic, Children's Hospital Colorado, Aurora, Colorado, USA.,Neurology and Neuropsychology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA
| | - Judith Ross
- Pediatric Endocrinology, University of Colorado School of Medicine Department of Pediatrics, Aurora, Colorado, USA.,Department of Pediatric Endocrinology, Nemours-Dupont Hospital for Children, Wilmington, Delaware, USA
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18
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Fainberg J, Hayden RP, Schlegel PN. Fertility management of Klinefelter syndrome. Expert Rev Endocrinol Metab 2019; 14:369-380. [PMID: 31587581 DOI: 10.1080/17446651.2019.1671821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
Introduction: Klinefelter syndrome (KS) represents the most common chromosomal abnormality in the general population, and one of the most common genetic etiologies of nonobstructive azoospermia (NOA) and in severe oligospermia. Once considered untreatable, men with KS and NOA now have a variety of treatment options to obtain paternity.Areas covered: The cornerstone of treatment for both KS and NOA patients remains the surgical retrieval of viable sperm, which can be used for intracytoplasmic sperm injection to obtain pregnancy. Although the field has advanced significantly since the early 1990s, approximately half of men with KS will ultimately fail fertility treatments. Presented is a critical review of the available evidence that has attempted to identify predictive factors for successful sperm recovery. To optimize surgical success, a variety of treatment modalities have also been suggested and evaluated, including hormonal manipulation and timing of retrieval.Expert opinion: Individuals with KS have a relatively good prognosis for sperm recovery compared to other men with idiopathic NOA. Surgical success is heavily dependent upon surgical technique and the experience of the andrology/embryology team tasked with the identification and use of testicular sperm.
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Affiliation(s)
| | - Russell P Hayden
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Peter N Schlegel
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
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19
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Laurentino S, Heckmann L, Di Persio S, Li X, Meyer Zu Hörste G, Wistuba J, Cremers JF, Gromoll J, Kliesch S, Schlatt S, Neuhaus N. High-resolution analysis of germ cells from men with sex chromosomal aneuploidies reveals normal transcriptome but impaired imprinting. Clin Epigenetics 2019; 11:127. [PMID: 31462300 PMCID: PMC6714305 DOI: 10.1186/s13148-019-0720-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/02/2019] [Indexed: 12/18/2022] Open
Abstract
Background The most common sex chromosomal aneuploidy in males is Klinefelter syndrome, which is characterized by at least one supernumerary X chromosome. While these men have long been considered infertile, focal spermatogenesis can be observed in some patients, and sperm can be surgically retrieved and used for artificial reproductive techniques. Although these gametes can be used for fertility treatments, little is known about the molecular biology of the germline in Klinefelter men. Specifically, it is unclear if germ cells in Klinefelter syndrome correctly establish the androgenetic DNA methylation profile and transcriptome. This is due to the low number of germ cells in the Klinefelter testes available for analysis. Results Here, we overcame these difficulties and successfully investigated the epigenetic and transcriptional profiles of germ cells in Klinefelter patients employing deep bisulfite sequencing and single-cell RNA sequencing. On the transcriptional level, the germ cells from Klinefelter men clustered together with the differentiation stages of normal spermatogenesis. Klinefelter germ cells showed a normal DNA methylation profile of selected germ cell-specific markers compared with spermatogonia and sperm from men with normal spermatogenesis. However, germ cells from Klinefelter patients showed variations in the DNA methylation of imprinted regions. Conclusions These data indicate that Klinefelter germ cells have a normal transcriptome but might present aberrant imprinting, showing impairment in germ cell development that goes beyond mere germ cell loss. Electronic supplementary material The online version of this article (10.1186/s13148-019-0720-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Laurentino
- Centre of Reproductive Medicine and Andrology, University of Münster, Domagkstrasse 11, 48149, Münster, Germany
| | - Laura Heckmann
- Centre of Reproductive Medicine and Andrology, University of Münster, Domagkstrasse 11, 48149, Münster, Germany
| | - Sara Di Persio
- Centre of Reproductive Medicine and Andrology, University of Münster, Domagkstrasse 11, 48149, Münster, Germany
| | - Xiaolin Li
- Department of Neurology, Institute of Translational Neurology, University Hospital of Münster, Münster, Germany
| | - Gerd Meyer Zu Hörste
- Department of Neurology, Institute of Translational Neurology, University Hospital of Münster, Münster, Germany
| | - Joachim Wistuba
- Centre of Reproductive Medicine and Andrology, University of Münster, Domagkstrasse 11, 48149, Münster, Germany
| | - Jann-Frederik Cremers
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, Münster, Germany
| | - Jörg Gromoll
- Centre of Reproductive Medicine and Andrology, University of Münster, Domagkstrasse 11, 48149, Münster, Germany
| | - Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, Münster, Germany
| | - Stefan Schlatt
- Centre of Reproductive Medicine and Andrology, University of Münster, Domagkstrasse 11, 48149, Münster, Germany
| | - Nina Neuhaus
- Centre of Reproductive Medicine and Andrology, University of Münster, Domagkstrasse 11, 48149, Münster, Germany.
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20
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Sciarra F, Pelloni M, Faja F, Pallotti F, Martino G, Radicioni AF, Lenzi A, Lombardo F, Paoli D. Incidence of Y chromosome microdeletions in patients with Klinefelter syndrome. J Endocrinol Invest 2019; 42:833-842. [PMID: 30499012 DOI: 10.1007/s40618-018-0989-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/21/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to study the incidence of Y chromosome microdeletions in a Caucasian population of Klinefelter syndrome (KS) patients and to investigate the possible association between Y chromosome microdeletions and KS. MATERIALS AND METHODS We conducted a retrospective study on 118 KS patients, 429 patients with non-obstructive azoospermia (NOA), and 155 normozoospermic men. Eight of the 118 KS patients had undergone testicular sperm extraction (TESE). All patients underwent semen examination and Y chromosome microdeletions evaluated by PCR, using specific sequence tagged site (STS) primer sets, which spanned the azoospermia factor AZFa, AZFb, and AZFc regions of the Y chromosome. RESULTS Semen analysis of the KS group revealed: 1 patient with oligozoospermia, 1 with severe oligoasthenoteratozoospermia, 2 with cryptozoospermia, and 114 with azoospermia. Eight of the 114 azoospermic KS patients underwent TESE, and spermatozoa were recovered from three of these, all of whom had non-mosaic karyotype 47, XXY. 10.7% of the NOA patients presented AZF microdeletions. In 429 cases with NOA, 8 cases had AZFa + b + c deletion, 6 cases had AZF b + c deletion, 4 cases had AZFa microdeletion, 8 cases had AZFb microdeletion, and 20 cases had AZFc microdeletion. Just one KS patient (0.8%) presented microdeletion in the AZFc region. CONCLUSION The percentage of microdeletions in KS patients was lower than in NOA patients, suggesting that AZF microdeletions and KS do not have a causal relationship and that Y chromosome microdeletions are not a genetic factor linked to KS.
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Affiliation(s)
- F Sciarra
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M Pelloni
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Faja
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - G Martino
- Department of Surgical Sciences "R. Paolucci", "Sapienza" University of Rome, Rome, Italy
| | - A F Radicioni
- Hormone Laboratory, Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome, Italy
| | - A Lenzi
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - D Paoli
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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21
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Ferlin A, Dipresa S, Delbarba A, Maffezzoni F, Porcelli T, Cappelli C, Foresta C. Contemporary genetics-based diagnostics of male infertility. Expert Rev Mol Diagn 2019; 19:623-633. [DOI: 10.1080/14737159.2019.1633917] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alberto Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Savina Dipresa
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Andrea Delbarba
- Unit of Endocrinology and Metabolism, Department of Medicine, ASST Spedali Civili Brescia, Brescia, Italy
| | - Filippo Maffezzoni
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Teresa Porcelli
- Endocrinology, Montichiari Hospital, ASST Spedali Civili Brescia, Montichiari, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - Carlo Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
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22
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Seminiferous tubule molecular imaging for evaluation of male fertility: Seeing is believing. Tissue Cell 2019; 58:24-32. [PMID: 31133243 DOI: 10.1016/j.tice.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/28/2019] [Accepted: 04/05/2019] [Indexed: 01/15/2023]
Abstract
The proper assessment of male fertility is essential for diagnosing and treating male infertility. Currently, spermiogram and Johnsen testicular biopsy score counts are used to assess male fertility. However, spermiogram is not a suitable option for non-obstructive azoospermia patients, and Johnsen testicular biopsy scores only represent localized and not the overall spermatogenesis. Whole-mount staining was a novel method for evaluating protein expression in the tissue. Thus, we explored its application in human seminiferous tubules. Testicular biopsies from 57 azoospermia patients were categorized as obstructive azoospermia (OA), maturation arrest (MA) and Sertoli-cells only syndrome (SCOS). We performed whole-mount staining of their seminiferous tubules and evaluated the spermatogonial stem cells (SSCs), differentiated spermatogonia (SG), spermatocytes (SPC) and spermatids (SD) with their respective markers (GFRA1, CD117, SYCP3, and PNA) to assess fertility. GFRA1, CD117, SYCP3, and PNA were not expressed in SCOS patients, whereas all of them were detected in OA patients. In MA patients with arrested spermatogenesis at the SPC stage, GFRA1, CD117, and SYCP3, but not PNA were expressed in the seminiferous tubules. In MA patients with arrested spermatogenesis at the spermatogonia stage, only GFRA1 was expressed in the seminiferous tubules. These results were consistent with the Johnsen testicular biopsy score counts except for one patient, where although only Sertoli cells were indicated by the score, SSCs were also detected in the whole-mounts. Collectively, whole-mount staining could be used to analyze the inherent spermatogenesis of seminiferous tubules through staining of germ cells at different stages. It offers a more accurate and promising faster method for assessing male fertility compared with traditional biopsy screening. And it could have potential value for the clinical purpose for male fertility management.
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Reproductive success of assisted reproductive technology in couples with chromosomal abnormalities. J Assist Reprod Genet 2019; 36:1471-1479. [PMID: 31104291 DOI: 10.1007/s10815-019-01486-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/09/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Infertility is estimated to affect 15% of couples, having chromosome abnormalities an important role in its etiology. The main objective of this work was to access the reproductive success of ART in infertile couples with chromosomal abnormalities comparing to a control group with normal karyotype. METHODS A 7-year retrospective karyotype analysis of infertile couples was done. Data regarding type of infertility, couples' ages, ART performed, and their reproductive success were obtained. Adjusted odds ratio (OR) were used to estimate magnitude of association between the reproductive success and the different groups. RESULTS We found a prevalence of 7.83% of chromosome abnormalities in our population (233 couples out of 2989). Chromosomal anomalies were found in 82 men (34.75%) and 154 women (65.25%), with low-grade mosaicism being the most prevalent (50.85%), followed by autosomal translocations (17.37%) and sex chromosomes abnormalities (13.56%). Only 2359 couples were treated with ART. There was a non-significant lower reproductive success rate in the cases (OR = 0.899, p = 0.530) with IVF providing the higher success rate. In general, female carriers of chromosome anomalies had a higher success rate, although not significant. CONCLUSION Although the differences regarding success rate between groups were not found statistically significant, we still advocate that cytogenetic analysis should be performed routinely in all infertile couples namely before ART. This might help deciding the best treatment options including Preimplantation Genetic Testing for aneuploidies or structural rearrangements and minimize the risk of transmission of anomalies to the offspring.
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Lopes AC, Oliveira PF, Sousa M. Shedding light into the relevance of telomeres in human reproduction and male factor infertility†. Biol Reprod 2018; 100:318-330. [DOI: 10.1093/biolre/ioy215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/05/2018] [Accepted: 10/01/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ana Catarina Lopes
- Laboratory of Cell Biology, Department of Microscopy, and Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Department of Life Sciences, Faculty of Sciences and Technology, New University of Lisbon (FCT-UNL), Campus Caparica, Caparica, Portugal
| | - Pedro F Oliveira
- Laboratory of Cell Biology, Department of Microscopy, and Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
- i3S- Institute of Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Mário Sousa
- Laboratory of Cell Biology, Department of Microscopy, and Multidisciplinary Unit for Biomedical Research (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Centre for Reproductive Genetics Professor Alberto Barros, Porto, Portugal
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Yu Y, Xi Q, Jing J, Li L, Zhang H, Liu R, Pan Y. Intracytoplasmic sperm injection outcome of ejaculated spermatozoa from a man with mosaic Klinefelter's Syndrome: case report and literature review. J Int Med Res 2018; 46:4323-4331. [PMID: 30060725 PMCID: PMC6166348 DOI: 10.1177/0300060518788757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To report a case of abortion after intracytoplasmic sperm injection (ICSI)
with ejaculated spermatozoa obtained from a man with mosaic Klinefelter’s
syndrome. Methods Sperm nuclei from the patient were analyzed by fluorescence in
situ hybridization, and the disomy frequencies for chromosome
18 and the sex chromosomes were determined. A literature review of the ICSI
outcome of ejaculated sperm in patients with Klinefelter’s syndrome was also
performed. Results A total of 108 spermatozoa nuclei were analyzed. Of these, 102 sperm cells
were normal with an X18 (55.56%) or Y18 (38.89%) chromosome pattern. Three
cells with XX18 (2.78%) and three cells with YY18 (2.78%) signals were
detected. The fetus stopped developing in the eighth week. The karyotype
determined by an analysis of the abortive tissue was 46, XY. The literature
review identified a total of 12 patients who were analyzed in 11 reports.
The fertilization rate was 80.9%, and the live birth rate per transfer was
71.4%. Conclusions ICSI with ejaculated spermatozoa from men with Klinefelter’s syndrome can
lead to pregnancy, for which the risk of transmission of chromosomal
aneuploidy is low.
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Affiliation(s)
- Yang Yu
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, the First Hospital, Jilin University, Changchun, PR China
| | - Qi Xi
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, the First Hospital, Jilin University, Changchun, PR China
| | - Jili Jing
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, the First Hospital, Jilin University, Changchun, PR China
| | - Linlin Li
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, the First Hospital, Jilin University, Changchun, PR China
| | - Hongguo Zhang
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, the First Hospital, Jilin University, Changchun, PR China
| | - Ruizhi Liu
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, the First Hospital, Jilin University, Changchun, PR China
| | - Yuan Pan
- Centre for Reproductive Medicine, Centre for Prenatal Diagnosis, the First Hospital, Jilin University, Changchun, PR China
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Yu Z, Wei Z, Yang J, Wang T, Jiang H, Li H, Tang Z, Wang S, Liu J. Comparison of intracytoplasmic sperm injection outcome with fresh versus frozen-thawed testicular sperm in men with nonobstructive azoospermia: a systematic review and meta-analysis. J Assist Reprod Genet 2018; 35:1247-1257. [PMID: 29785532 PMCID: PMC6063825 DOI: 10.1007/s10815-018-1206-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/09/2018] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The purpose of the study is to explore testicular sperm cryopreservation in patients with nonobstructive azoospermia (NOA) whether affect the outcome of subsequent intracytoplasmic sperm injection (ICSI). METHODS A systematic review and meta-analysis was conducted by searching the MEDLINE and EMBASE databases for relevant published studies in English language (1997-2017). Studies were eligible if they included the comparison of using fresh and frozen-thawed testicular sperm followed by ICSI. Two reviewers independently performed data extraction, quality assessment and assessed the risk of bias. The overall summary risk estimated the number of events. A meta-analysis was conducted using a random effects or fixed effects model analysis according to the test of heterogeneity. RESULTS A total of 17 studies with 1,261 ICSI cycles were identified. Analysis of the present data showed no difference in the fertilization outcome when comparing fresh versus frozen-thawed spermatozoa (RR = 1.02, 95% CI 0.86-1.09). Similarly, no difference in CR (RR = 1.01, 95% CI 0.96-1.05), good embryo rate (RR = 1.01, 95% CI 0.95-1.09), and IR (RR = 0.93, 95% CI 0.66-1.30) was observed if the spermatozoa was fresh or frozen-thawed. Finally, no difference in CPR or LBR was noted when using fresh or frozen-thawed cycles were analyzed separately (RR = 1.03, 95% CI 0.86-1.24; RR 1.11, 95% CI 0.88-1.41, respectively). CONCLUSIONS In men with NOA, the ICSI outcome is not affected by whether the retrieved testicular sperm is fresh or frozen. Sperm cryopreservation ought to be considered in every surgical sperm retrieval case, which remain feasible even in patients with few testicular sperm retrieved.
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Affiliation(s)
- Zhe Yu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhewen Wei
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyang Jiang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Ragab MW, Cremers JF, Zitzmann M, Nieschlag E, Kliesch S, Rohayem J. A history of undescended testes in young men with Klinefelter syndrome does not reduce the chances for successful microsurgical testicular sperm extraction. Andrology 2018; 6:525-531. [DOI: 10.1111/andr.12503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/28/2018] [Accepted: 04/19/2018] [Indexed: 12/01/2022]
Affiliation(s)
- M. W. Ragab
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
- Department of Clinical and Surgical Andrology; Cairo University; Cairo Egypt
| | - J.-F. Cremers
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - M. Zitzmann
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - E. Nieschlag
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - S. Kliesch
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - J. Rohayem
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
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Klami R, Mankonen H, Perheentupa A. Successful microdissection testicular sperm extraction for men with non-obstructive azoospermia. Reprod Biol 2018; 18:137-142. [DOI: 10.1016/j.repbio.2018.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 01/27/2023]
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Chihara M, Ogi K, Ishiguro T, Yoshida K, Godo C, Takakuwa K, Enomoto T. Microdissection testicular sperm extraction in five Japanese patients with non-mosaic Klinefelter's syndrome. Reprod Med Biol 2018; 17:209-216. [PMID: 29692680 PMCID: PMC5902470 DOI: 10.1002/rmb2.12092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/24/2018] [Indexed: 11/25/2022] Open
Abstract
Cases Microdissection testicular sperm extraction (micro‐TESE) was performed on five Japanese men with non‐mosaic Klinefelter's syndrome (KS) and non‐obstructive azoospermia in the authors' department. Here is reported the operative results and partner's clinical course for two cases where spermatozoa could be acquired. Also encountered was a man with non‐mosaic KS with the partial deletion of azoospermia factor (AZF)b. Because this is rare, it is reported in detail in the context of the previous literature. This case series describes the first experience of micro‐TESE by gynecologists in the current department. Outcome The egg collection date was adjusted to the micro‐TESE day by using the modified ultra‐long method. Intracytoplasmic sperm injection (ICSI) was implemented for two men whose spermatozoa were acquired by micro‐TESE, with these progressing to the blastocyst stage. Subsequently, one case conceived after the transfer of fresh embryos and a healthy baby was delivered. However, spermatozoa could not be retrieved from the man with non‐mosaic KS who was harboring the partial deletion of AZFb. Conclusion These findings suggest that ovulation induction by using the modified ultra‐long method with micro‐TESE and ICSI on the same day represents an effective treatment option for men with non‐mosaic KS. As there are cases where AZF deletion is recognized among patients with non‐mosaic KS, screening before micro‐TESE is strongly recommended.
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Affiliation(s)
- Makoto Chihara
- Department of Obstetrics and Gynecology Niigata University Medical and Dental Hospital Niigata Japan
| | - Kanna Ogi
- Department of Obstetrics and Gynecology Niigata University Medical and Dental Hospital Niigata Japan
| | - Tatsuya Ishiguro
- Department of Obstetrics and Gynecology Niigata University Medical and Dental Hospital Niigata Japan
| | - Kunihiko Yoshida
- Department of Obstetrics and Gynecology Niigata University Medical and Dental Hospital Niigata Japan
| | - Chikako Godo
- Department of Obstetrics and Gynecology Niigata University Medical and Dental Hospital Niigata Japan
| | - Koichi Takakuwa
- Department of Obstetrics and Gynecology Niigata University Medical and Dental Hospital Niigata Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology Niigata University Medical and Dental Hospital Niigata Japan
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30
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Ozer C, Caglar Aytac P, Goren MR, Toksoz S, Gul U, Turunc T. Sperm retrieval by microdissection testicular sperm extraction and intracytoplasmic sperm injection outcomes in nonobstructive azoospermic patients with Klinefelter syndrome. Andrologia 2018; 50:e12983. [PMID: 29460304 DOI: 10.1111/and.12983] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2018] [Indexed: 02/28/2024] Open
Abstract
Klinefelter syndrome is the most frequent chromosomal abnormality in patients with nonobstructive azoospermia. The development of advanced assisted reproductive techniques, such as testicular sperm extraction and intracytoplasmic sperm injection, has provided the possibility of biological fathering in nonobstructive azoospermic patients with Klinefelter syndrome. We aimed to evaluate our sperm retrieval rate by microdissection testicular sperm extraction and to analyse the intracytoplasmic sperm injection outcomes in these patients. Medical records of 110 nonobstructive azoospermic patients with Klinefelter syndrome were retrospectively reviewed. We found that the sperm retrieval rate by microdissection testicular sperm extraction is lower than published reports on other types of secretory azoospermia. The statistical analyses yielded that age, FSH and testosterone levels as predictive factors for successful sperm retrieval.
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Affiliation(s)
- C Ozer
- Department of Urology, Adana Dr. Turgut Noyan Medical and Research Center, Baskent University School of Medicine, Adana, Turkey
| | - P Caglar Aytac
- Department of Obstetrics and Gynecology, Adana Dr. Turgut Noyan Medical and Research Center, Baskent University School of Medicine, Adana, Turkey
| | - M R Goren
- Department of Urology, Adana Dr. Turgut Noyan Medical and Research Center, Baskent University School of Medicine, Adana, Turkey
| | - S Toksoz
- Department of Urology, Hatay State Hospital, Hatay, Turkey
| | - U Gul
- Department of Urology, Adana Dr. Turgut Noyan Medical and Research Center, Baskent University School of Medicine, Adana, Turkey
| | - T Turunc
- Department of Urology, Adana Dr. Turgut Noyan Medical and Research Center, Baskent University School of Medicine, Adana, Turkey
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31
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Lopes R, Sousa M, Silva J, Cunha M, Oliveira C, Teixeira da Silva J, Ferraz L, Coelho T, Carvalho F, Barros A. Clinical outcomes after preimplantation genetic diagnosis of patients with Corino de Andrade disease (familial amyloid polyneuropathy). Reprod Biomed Online 2018; 36:39-46. [DOI: 10.1016/j.rbmo.2017.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
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Klami R, Mankonen H, Perheentupa A. Microdissection testicular sperm extraction in Finland - results of the first 100 patients. Acta Obstet Gynecol Scand 2017; 97:53-58. [PMID: 28990672 DOI: 10.1111/aogs.13243] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/02/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Testicular microdissection sperm extraction (MD-TESE) combined with intracytoplasmic sperm injection (ICSI) has made biological fatherhood possible for many men with the most severe form of male infertility, non-obstructive azoospermia. MD-TESE was introduced in Turku in 2008, and by 2015, 100 Finnish men with non-obstructive azoospermia have been operated on. MATERIAL AND METHODS The average age of the men was 33 years at the time of surgery. Forty-eight had a needle biopsy previously and 56% had a testicular size <15 mL. The most common diagnoses were idiopathic (n = 65), Klinefelter syndrome (n = 15), operated cryptorchidism or torsion (n = 10), and Y chromosome microdeletion (n = 7). The pregnancy outcomes were followed. RESULTS The sperm recovery rate (SRR) overall was 42%: 31% for idiopathic non-obstructive azoospermia, 40% for Klinefelter syndrome, 57% for Y chromosome microdeletion AZFc, 90% for previous testicular surgery (mostly for cryptorchidism; n = 10) and 67% for previous cytotoxic treatment (n = 3). SRR with histopathologic diagnosis Sertoli-cell-only was 29%, and 44% for spermatogenic arrest. Age did not affect the outcome of the surgery. Small testicular size seemed to predict a higher SRR. A previous needle biopsy did not predict a lower SRR. Surgical complications were rare. Of couples, 32 had at least one ICSI attempt, and 22 at least one live birth, giving a cumulative live birth rate of 69%. No major pregnancy complications occurred. CONCLUSIONS Our SRR is comparable with international results, and the cumulative live birth rate similar to other ICSI indications in Finland. Physicians and specialists need to be made aware of new treatment options to enable biological fatherhood for men with non-obstructive azoospermia.
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Affiliation(s)
- Rauni Klami
- Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland.,Institute of Medicine, University of Turku, Turku, Finland
| | - Harri Mankonen
- Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland.,Institute of Medicine, University of Turku, Turku, Finland
| | - Antti Perheentupa
- Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland.,Institute of Medicine, University of Turku, Turku, Finland
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Corona G, Pizzocaro A, Lanfranco F, Garolla A, Pelliccione F, Vignozzi L, Ferlin A, Foresta C, Jannini EA, Maggi M, Lenzi A, Pasquali D, Francavilla S. Sperm recovery and ICSI outcomes in Klinefelter syndrome: a systematic review and meta-analysis. Hum Reprod Update 2017; 23:265-275. [PMID: 28379559 DOI: 10.1093/humupd/dmx008] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Specific factors underlying successful surgical sperm retrieval rates (SRR) or pregnancy rates (PR) after testicular sperm extraction (TESE) in adult patients with Klinefelter syndrome (KS) have not been completely clarified. OBJECTIVE AND RATIONALE The aim of this review was to meta-analyse the currently available data from subjects with KS regarding SRRs as the primary outcome. In addition, when available, PRs and live birth rates (LBRs) after the ICSI technique were also investigated as secondary outcomes. SEARCH METHODS An extensive Medline, Embase and Cochrane search was performed. All trials reporting SRR for conventional-TESE (cTESE) or micro-TESE (mTESE) and its specific determinants without any arbitrary restriction were included. OUTCOMES Out of 139 studies, 37 trials were included in the study, enrolling a total of 1248 patients with a mean age of 30.9 ± 5.6 years. The majority of the studies (n = 18) applied mTESE, 13 applied cTESE and in one case testicular sperm aspiration (TESA) was used. Additionally, four studies used a mixed approach and in one study, the method applied for sperm retrieval was not specified. Overall, a SRR per TESE cycle of 44[39;48]% was detected. Similar results were observed when mTESE was compared to cTESE (SRR 43[35;50]% vs 45[38;52]% for cTESE vs micro-TESE, respectively; Q = 0.20, P = 0.65). Meta-regression analysis showed that none of the parameters tested, including age, testis volume and FSH, LH and testosterone (T) levels at enrollment, affected the final SRR. Similarly, no difference was observed when a bilateral procedure was compared to a unilateral approach. No sufficient data were available to evaluate the effect of previous T treatment on SRR. Information on fertility outcome after ICSI was available for 29 studies. Overall a total of 218 biochemical pregnancies after 410 ICSI cycles were observed (PR = 43[36;50]%). Similar results were observed when LBR was analyzed (LBR = 43[34;53]%). Similar to what was observed for SRR, no influence of KS age, mean testis volume, LH, FSH or total T levels on either PR and LBR was observed. No sufficient data were available to test the effect of the women's age or other female fertility problems on PR and LBR. Finally, no difference in PR or LBR was observed when the use of fresh sperm was compared to the utilization of cryopreserved sperm. WIDER IMPLICATIONS The present data suggest that performing TESE/micro-TESE in subjects with KS results in SRRs of close to 50%, and then PRs and LBRs of close to 50%, with the results being independent of any clinical or biochemical parameters tested.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Endocrinology Unit, Azienda Usl Bologna Maggiore-Bellaria Hospital, Via Altura 3, 40139 Bologna, Italy
| | - Alessandro Pizzocaro
- Endocrinology Unit, IRCCS, Humanitas Research Hospital, Rozzano, Via Manzoni 56, 20089 Milan, Italy
| | - Fabio Lanfranco
- Department of Medical Sciences, Division of Endocrinology, Diabetology and Metabolism, University of Torino, Corso Dogliotti 14, 10126 Turin, Italy
| | - Andrea Garolla
- Department of Medicine, Andrology and Reproductive Medicine Unit, University of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Fiore Pelliccione
- Endocrinology Unit, IRCCS, Humanitas Research Hospital, Rozzano, Via Manzoni 56, 20089 Milan, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Sexual Medicine and Andrology Unit, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Alberto Ferlin
- Department of Medicine, Andrology and Reproductive Medicine Unit, University of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Carlo Foresta
- Department of Medicine, Andrology and Reproductive Medicine Unit, University of Padova, Via Giustiniani 2, 35100 Padova, Italy
| | - Emmanuele A Jannini
- Department of Systems Medicine, Tor Vergata University of Rome, Via Montpellier 1, 00166 Rome, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Sexual Medicine and Andrology Unit, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Daniela Pasquali
- Department of Cardiothoracic and Respiratory Sciences, Endocrine Unit, Second University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Sandro Francavilla
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Via Vetoio, 67100 L'Aquila, Italy
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Chehrazi M, Rahimiforoushani A, Sabbaghian M, Nourijelyani K, Sadighi Gilani MA, Hoseini M, Vesali S, Yaseri M, Alizadeh A, Mohammad K, Samani RO. Sperm Retrieval in Patients with Klinefelter Syndrome: A Skewed Regression Model Analysis. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:117-122. [PMID: 28670430 PMCID: PMC5347449 DOI: 10.22074/ijfs.2017.4702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 10/01/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The most common chromosomal abnormality due to non-obstructive azoospermia (NOA) is Klinefelter syndrome (KS) which occurs in 1-1.72 out of 500-1000 male infants. The probability of retrieving sperm as the outcome could be asymmetrically different between patients with and without KS, therefore logistic regression analysis is not a well-qualified test for this type of data. This study has been designed to evaluate skewed regression model analysis for data collected from microsurgical testicular sperm extraction (micro-TESE) among azoospermic patients with and without non-mosaic KS syndrome. MATERIALS AND METHODS This cohort study compared the micro-TESE outcome between 134 men with classic KS and 537 men with NOA and normal karyotype who were referred to Royan Institute between 2009 and 2011. In addition to our main outcome, which was sperm retrieval, we also used logistic and skewed regression analyses to compare the following demographic and hormonal factors: age, level of follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone between the two groups. RESULTS A comparison of the micro-TESE between the KS and control groups showed a success rate of 28.4% (38/134) for the KS group and 22.2% (119/537) for the control group. In the KS group, a significantly difference (P<0.001) existed between testosterone levels for the successful sperm retrieval group (3.4 ± 0.48 mg/mL) compared to the unsuccessful sperm retrieval group (2.33 ± 0.23 mg/mL). The index for quasi Akaike information criterion (QAIC) had a goodness of fit of 74 for the skewed model which was lower than logistic regression (QAIC=85). CONCLUSION According to the results, skewed regression is more efficient in estimating sperm retrieval success when the data from patients with KS are analyzed. This finding should be investigated by conducting additional studies with different data structures.
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Affiliation(s)
- Mohammad Chehrazi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimiforoushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Keramat Nourijelyani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hoseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Vesali
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahad Alizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Kazem Mohammad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Omani Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Flannigan R, Schlegel PN. Genetic diagnostics of male infertility in clinical practice. Best Pract Res Clin Obstet Gynaecol 2017; 44:26-37. [PMID: 28601348 DOI: 10.1016/j.bpobgyn.2017.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 01/15/2023]
Abstract
Approximately 15% of couples are infertile. Male factors contribute to infertility in over 50% of cases. Identifiable genetic abnormalities contribute to 15%-20% of the most severe forms of male infertility, azoospermia. In this chapter, we explore known genetic causes of male infertility such as Klinefelter syndrome, XYY men, Kallmann syndrome, y-microdeletions, Robertsonian translocations, autosomal inversions, mixed gonadal dysgenesis, x-linked and autosomal gene mutations, and cystic fibrosis transmembrane conductance regulator abnormalities. We also briefly comment on novel biomarkers for male infertility.
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Vicdan K, Akarsu C, Sözen E, Buluç B, Vicdan A, Yılmaz Y, Biberoğlu K. Outcome of intracytoplasmic sperm injection using fresh and cryopreserved-thawed testıcular spermatozoa in 83 azoospermic men with Klinefelter syndrome. J Obstet Gynaecol Res 2017; 42:1558-1566. [PMID: 27785898 DOI: 10.1111/jog.13090] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/20/2016] [Accepted: 06/03/2016] [Indexed: 11/29/2022]
Abstract
AIM To report the outcome of intracytoplasmic sperm injection (ICSI) cycles using fresh or cryopreserved-thawed testicular spermatozoa of men with Klinefelter syndrome (KS). METHODS Medical records of 83 azoospermic men with KS who underwent testicular sperm extraction (TESE) were reviewed. The clinical parameters for predicting sperm retrieval and fertilization, implantation, pregnancy and live birth rates of ICSI cycles in these patients were evaluated. RESULTS A total of 88 TESE procedures were performed with sperm retrieval rates of 39.8% per cycle (35/88) and 42.1% per patient (35/83). None of the studied clinical parameters were found to be informative in predicting successful sperm recovery. A total of 41 embryo transfer cycles were carried out using fresh testicular spermatozoa in 30, cryopreserved-thawed spermatozoa in 10 and cryopreserved-thawed embryo replacement in one. The fertilization and clinical pregnancy rates were comparable at 52.7% and 51.6% with fresh and 48.3% and 60% with cryopreserved-thawed testicular spermatozoa groups, respectively. Twenty-two clinical pregnancies were obtained, including 14 singletons, five twins, two triplets and one quadruplet and ended with the delivery of 13 singletons and six twins. In total, out of 25 delivered fetuses, four died (3 female, 1 male) following delivery and 21 newborns (14 female, 7 male) were healthy with a female to male ratio of 2:1. Conclusions We concluded that no clinical or laboratory parameter predicts the presence of spermatozoa in patients with KS, except the TESE procedure itself. The use of fresh or cryopreserved-thawed spermatozoa on ICSI cycle outcomes are equally successful in patients with KS.
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Affiliation(s)
| | - Cem Akarsu
- Ankara Private IVF Center, Ankara, Turkey
| | - Eran Sözen
- Ankara Private IVF Center, Ankara, Turkey
| | | | - Arzu Vicdan
- Department of Genetics, Ankara University Medical School, Ankara, Turkey
| | | | - Kutay Biberoğlu
- Department of Obcstetric and Gynecology, Gazi University Medical School, Ankara, Turkey
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Miki T, Nagayoshi M, Takemoto Y, Yamaguchi T, Takeda S, Watanabe S, Tanaka A. Genetic risk of Klinefelter's syndrome in assisted reproductive technology. Reprod Med Biol 2017; 16:188-195. [PMID: 29259468 PMCID: PMC5661818 DOI: 10.1002/rmb2.12029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
Aim The main cause of Klinefelter's syndrome (KS) has been believed to be XY sperm. Accordingly, in the intracytoplasmic sperm injection treatment of patients with KS, hereditary KS has been a concern. Therefore, this study attempted to estimate the risk before and after the assisted reproductive technology. Methods First, in order to validate the safety of the gametes of the patients with KS, a fluorescent in situ hybridization (FISH) analysis, following an original cell identification method using 1052 testicular gametes of 30 patients, was conducted. Second, in the resultant 45 babies, cytogenetic and physical-cognitive screening data were analyzed. In addition, a first attempt was conducted to investigate the origin of the extra X chromosome in 11 patients with KS by using 12 X-chromosome short tandem repeat (STR) analysis in order to estimate the paternal contribution to KS. Results No sex chromosomally abnormal gamete was found in the FISH analysis and the babies were normal genetically, physically, and cognitively. In the STR, it was confirmed that most (7/11) of the patients with KS resulted from the fertilization of the XX oocytes, suggesting that a baby with KS that had been reported previously might not have resulted from XY sperm. Conclusion These results indicate that the risk of assisted reproductive technology for patients with KS is not as high as previously expected.
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Affiliation(s)
- Tamito Miki
- Saint Mother Obstetrics and Gynecology Clinic and Institute for ART Kitakyushu Japan.,Department of Obstetrics and Gynecology Juntendo University School of Medicine Tokyo Japan
| | - Motoi Nagayoshi
- Saint Mother Obstetrics and Gynecology Clinic and Institute for ART Kitakyushu Japan
| | - Yoichi Takemoto
- Saint Mother Obstetrics and Gynecology Clinic and Institute for ART Kitakyushu Japan
| | - Takashi Yamaguchi
- Saint Mother Obstetrics and Gynecology Clinic and Institute for ART Kitakyushu Japan.,Department of Obstetrics and Gynecology Juntendo University School of Medicine Tokyo Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynecology Juntendo University School of Medicine Tokyo Japan
| | - Seiji Watanabe
- Department of Anatomical Science Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Atsushi Tanaka
- Saint Mother Obstetrics and Gynecology Clinic and Institute for ART Kitakyushu Japan
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Testis Transcriptome Modulation in Klinefelter Patients with Hypospermatogenesis. Sci Rep 2017; 7:45729. [PMID: 28361989 PMCID: PMC5374630 DOI: 10.1038/srep45729] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/02/2017] [Indexed: 12/15/2022] Open
Abstract
The main genetic cause of male infertility is represented by the Klinefelter Syndrome (KS), a condition accounting for 3% of all cases of infertility and up to15% of cases of azoospermia. KS is generally characterized by azoospermia; approximately 10% of cases have severe oligozoospermia. Among these, the 30-40% of patients show hypospermatogenesis. The mechanisms leading to adult testis dysfunctions are not completely understood. A microarray transcriptome analysis was performed on testis biopsies obtained from three KS patients with hypospermatogenesis and three control subjects. KS testis showed a differential up- and down-regulation of 303 and 747 transcripts, respectively, as compared to controls. The majority of down-regulated transcripts were involved in spermiogenesis failure and testis morphological defects, whereas up-regulated genes were responsible for testis apoptotic processes. Functional analysis of the transcriptionally altered genes indicated a deregulation in cell death, germ cell function and morphology as well as blood-testis-barrier maintenance and Leydig cells activity. These data support a complex scenario in which spermatogenic impairment is the result of functional and morphological alterations in both germinal and somatic components of KS testis. These findings could represent the basis for evaluating new markers of KS spermatogenesis and potential targets of therapeutic intervention to preserve residual spermatogenesis.
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Rohayem J, Nieschlag E, Zitzmann M, Kliesch S. Testicular function during puberty and young adulthood in patients with Klinefelter's syndrome with and without spermatozoa in seminal fluid. Andrology 2016; 4:1178-1186. [PMID: 27611179 DOI: 10.1111/andr.12249] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 02/05/2023]
Abstract
Patients with Klinefelter's syndrome experience progressive testicular degeneration resulting in impaired endocrine function and azoospermia. What proportion of adolescents develop testosterone deficiency during puberty and how many have spermatozoa in their semen is unclear to date. We aimed to investigate testicular function during puberty and young adulthood in patients with Klinefelter's syndrome and to assess testosterone effects in target tissues. The clinical data of 281 patients with non-mosaic Klinefelter's syndrome aged 10-25 years without previous testosterone replacement were reviewed. In late pubertal adolescents, semen analyses were evaluated, and testicular volumes, hormone and haemoglobin (Hb) levels, the number of CAG repeats and final height data were compared to those of 233 age-matched controls with pubertal gynaecomastia. Spontaneous pubertal virilisation to Tanner stages IV-V occurred. Serum T levels ≥10 nmol/L were reached in 62% of patients with Klinefelter's syndrome and in 85% of controls at ages 15-25 (TKFS : 12.2 ± 5.4 vs. TC : 16.6 ± 7.2 nmol/L). LHKFS levels were elevated >10 U/L in 84%, and normal in all controls (LHKFS : 18.6 ± 12.2 vs. LHC : 3.5 ± 1.6 U/L). In nine of 130 (7%) adolescents with Klinefelter's syndrome, spermatozoa (oligozoospermia) were found in semen; all had T levels >7 nmol/L and eight of nine had LH levels ≤18 U/L, while their hormone levels, number of CAG repeats and testicular volumes were not different from those of adolescents with azoospermia. Controls had normal sperm concentrations in 73% (46/63). Semen volumesKFS were normal in 55% vs. 78% in controls; HbKFS was normal in 89% (HbC : 97%). Mean final heightKFS was 185 ± 8 cm vs. 181 ± 7 cm in controls. Hypergonadotropic hypogonadism develops during early puberty in adolescents with Klinefelter's syndrome and remains compensated in over 60% during ages 15-25, with sufficient testosterone secretion for spontaneous accomplishment of pubertal development. Spermatozoa in semen are rare and associated with T levels >7 nmol/L. Parameters reflecting androgen deficiency in target tissues may help to optimise timing of testosterone substitution, which should preferably not be initiated before fertility status has been clarified.
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Affiliation(s)
- J Rohayem
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - E Nieschlag
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - M Zitzmann
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - S Kliesch
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
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Abstract
In recent years, there has been increasing interest in transitional urology, or how to best prepare patients with major congenital urologic diseases, such as bladder exstrophy and neuropathic bladder, to manage their own health care with adult urologists. However, common pediatric urologic conditions may be encountered by the adult urologist with more regularity. This review focuses on three relatively common conditions which may be identified in childhood, the consequences from which a patient may seek help from an adult urologist: cryptorchidism, varicocele, and Klinefelter syndrome.
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Affiliation(s)
- Kristina D Suson
- Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI, 48201, USA.
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41
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42
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Milachich T, Shterev A. Are there optimal numbers of oocytes, spermatozoa and embryos in assisted reproduction? JBRA Assist Reprod 2016; 20:142-9. [PMID: 27584608 PMCID: PMC5264380 DOI: 10.5935/1518-0557.20160032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this overview is to discuss the current information about the search for the optimum yield of gametes in assisted reproduction, as one of the major pillars of IVF success. The first topic is focused on the number of male gametes and the possible impact of some genetic traits on these parameters. The number of spermatozoa did not seem to be crucial when there is no severe male factor of infertility. Genetic testing prior to using those sperm cells is very important. Different methods were applied in order to elect the "best" spermatozoa according to specific indications. The next problem discussed is the importance of the number of oocytes collected. Several studies have agreed that "15 oocytes is the perfect number," as the number of mature oocytes is more important. However, if elective single embryo transfer is performed, the optimal number of oocytes will enable a proper embryo selection. The third problem discussed concerns fertility preservation. Many educational programs promote and encourage procreation at maternal ages between 20-35 years, since assisted reproduction is unable to fully overcome the effects of female aging and fertility loss after that age. It is also strongly recommended to ensure a reasonable number of cryopreserved mature oocytes, preferably in younger ages (<35), for which an average of two stimulation cycles are likely required. For embryo cryopreservation, the "freeze all" strategy suggests the vitrification of good embryos, therefore quality is prior to number and patient recruitment for this strategy should be performed cautiously.
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Mascarenhas M, Thomas S, Kamath MS, Ramalingam R, Kongari AM, Yuvarani S, Srivastava VM, George K. Prevalence of chromosomal abnormalities and Y chromosome microdeletion among men with severe semen abnormalities and its correlation with successful sperm retrieval. J Hum Reprod Sci 2016; 9:187-193. [PMID: 27803587 PMCID: PMC5070401 DOI: 10.4103/0974-1208.192065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/15/2016] [Accepted: 06/22/2016] [Indexed: 12/03/2022] Open
Abstract
AIM To estimate the prevalence of chromosomal abnormalities and Y chromosome microdeletion among men with azoospermia and severe oligozoospermia and its correlation with successful surgical sperm retrieval. SETTING AND DESIGN A prospective study in a tertiary level infertility unit. MATERIALS AND METHODS In a prospective observation study, men with azoospermia and severe oligozoospermia (concentration <5 million/ml) attending the infertility center underwent genetic screening. Peripheral blood karyotype was done by Giemsa banding. Y chromosome microdeletion study was performed by a multiplex polymerase chain reaction. RESULTS The study group consisted of 220 men, 133 of whom had azoospermia and 87 had severe oligozoospermia. Overall, 21/220 (9.5%) men had chromosomal abnormalities and 13/220 (5.9%) men had Y chromosome microdeletions. Chromosomal abnormalities were seen in 14.3% (19/133) of azoospermic men and Y chromosome microdeletions in 8.3% (11/133). Of the 87 men with severe oligozoospermia, chromosomal abnormalities and Y chromosome microdeletions were each seen in 2.3% (2/87). Testicular sperm aspiration was done in 13 men and was successful in only one, who had a deletion of azoospermia factor c. CONCLUSIONS Our study found a fairly high prevalence of genetic abnormality in men with severe semen abnormalities and a correlation of genetic abnormalities with surgical sperm retrieval outcomes. These findings support the need for genetic screening of these men prior to embarking on surgical sperm retrieval and assisted reproductive technology intracytoplasmic sperm injection.
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Affiliation(s)
- Mariano Mascarenhas
- Leeds Centre for Reproductive Medicine, Seacroft Hospital, Leeds, United Kingdom
| | - Sumi Thomas
- Reproductive Medicine Unit, Christian Medical College and Hospital, Vellore, India
| | - Mohan S. Kamath
- Reproductive Medicine Unit, Christian Medical College, Vellore, India
| | | | - Ann Marie Kongari
- Reproductive Medicine Unit, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - S Yuvarani
- Cytogenetics Unit, Christian Medical College, Vellore, India
| | - Vivi M. Srivastava
- Cytogenetics Unit, Christian Medical College and Hospital, Vellore, India
| | - Korula George
- Reproductive Medicine Unit, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
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44
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45
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46
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Rogol AD, Skakkebaek NE. Sperm retrieval in adolescent males with Klinefelter syndrome: medical and ethical issues. Transl Pediatr 2016; 5:104-6. [PMID: 27186531 PMCID: PMC4855199 DOI: 10.21037/tp.2016.04.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alan D Rogol
- 1 Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA ; 2 Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - Niels E Skakkebaek
- 1 Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA ; 2 Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
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47
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Ali Jorsaraei SG, Shafi H, Alereza H, Esmailzadeh S, Delavar MA, Saee A, Fasihiyan M, Golsorkhtabaramiri M. Azoospermia and testicular biopsy before intra-cytoplasmic sperm injection: Does the type of anesthesia make a difference? J Nat Sci Biol Med 2016; 7:89-92. [PMID: 27003978 PMCID: PMC4780176 DOI: 10.4103/0976-9668.175087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim: Azoospermia is the most common form of male factor infertility, due to which sperms are retrieved for intra-cytoplasmic sperm injection (ICSI) under general or local anesthesia. The aim of the present study was to compare the efficacy of general and local anesthesia in an attempt to extract a sufficient quality of sperm for men with azoospermia, who intend to undergo ICSI. Materials and Methods: A total number of 50 patients with azoospermia, who were within the age range of 20-40, were randomly scheduled for testicular sperm extraction with either general or local anesthesia before ICSI. The hormonal abnormalities and severe varicocele were evaluated and treated before the testicular sperm extraction. The inclusion criteria obliged the researchers to focus on men with azoospermic, those who were diagnosed by two semen analyses after a 3-day abstinence from coitus according to the modified WHO criteria, and 19< body mass index ≤28. The concentration, motility, and morphology of the spermatozoa of the two groups were also compared. Results: A total number of 76 men, with a mean age of 35.1 ± 6.0, were selected, 26 were excluded from the study, and the remaining participants were randomly divided into two groups such as general anesthesia and lidocaine group. According to the results, the differences between the values of sperm parameters within various hours after the testicle biopsy were not statistically significant. Also, there was no significant difference between the two groups in terms of sperm motility and sperm morphology during various timing after the processing. Conclusion: The present study demonstrated that there was no evidence found for values of sperm parameters between the two groups, undergoing local and general anesthesia, within various hours after the testicular biopsy. Further investigations with more focus on concentration-dependent lidocaine on human sperm parameters need to be carried out.
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Affiliation(s)
| | - Hamid Shafi
- Department of Surgery, Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Hakimeh Alereza
- Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Sedigheh Esmailzadeh
- Department of Obstetrics and Gynecology, Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Mouloud Agajani Delavar
- Department of Midwifery, Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Ali Saee
- Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Maedeh Fasihiyan
- Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran
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Nahata L, Yu RN, Paltiel HJ, Chow JS, Logvinenko T, Rosoklija I, Cohen LE. Sperm Retrieval in Adolescents and Young Adults with Klinefelter Syndrome: A Prospective, Pilot Study. J Pediatr 2016; 170:260-5.e1-2. [PMID: 26746120 DOI: 10.1016/j.jpeds.2015.12.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/20/2015] [Accepted: 12/07/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess sperm retrieval rates in adolescents and young adults with Klinefelter syndrome, with the ultimate goal of improving fertility in this population. Secondary aims were to evaluate other clinical characteristics of the cohort and identify predictors of sperm retrieval. STUDY DESIGN Patients 12-25 years of age with Klinefelter syndrome (47,XXY) were recruited at the Boston Children's Hospital. Physical examination, biochemical evaluation, scrotal ultrasonography, and semen analysis were performed. Neurocognitive data were collected. Microdissection sperm extraction (unilateral micro-testicular sperm extraction) was offered to individuals with no sperm in their ejaculates. Given the small sample size, analysis was primarily descriptive. RESULTS Fifteen patients were enrolled. None had sperm in their ejaculates. Ten patients underwent unilateral micro-testicular sperm extraction. Sperm retrieval rate was 50%. From a neurocognitive standpoint, subjects reported problems with peers, conduct, and overall difficulties. Incidentally, one-third of the patients were found to have testicular microlithiasis and 17% of subjects with renal ultrasound imaging had bilateral renal medullary nephrocalcinosis. CONCLUSIONS This pilot study suggests that sperm retrieval rates in adolescents and young adults with Klinefelter syndrome are comparable with those reported in older men. However, larger studies are needed to confirm our findings. The clinical significance of the scrotal and renal ultrasound findings merits further investigation. TRIAL REGISTRATION ClinicalTrials.gov: NCT01817296.
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Affiliation(s)
- Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, OH.
| | - Richard N Yu
- Department of Urology, Boston Children's Hospital, Boston, MA
| | | | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, Boston, MA
| | - Tanya Logvinenko
- Department of Urology, Boston Children's Hospital, Boston, MA; Clinical Research Center, Boston Children's Hospital, Boston, MA
| | - Ilina Rosoklija
- Department of Urology, Boston Children's Hospital, Boston, MA
| | - Laurie E Cohen
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
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Abstract
Prenatal diagnostic testing is available for a growing number of disorders. The goal of prenatal diagnosis was initially focused on the identification of Down syndrome in women aged 35 years and older, but invasive prenatal genetic techniques can now detect a far broader array of conditions. The risks of invasive procedures have also decreased over time. Advances in genomic medicine allow testing for smaller but significant chromosomal abnormalities known as copy number variants, in addition to major aneuploidies and structural rearrangements. Molecular DNA techniques can detect many single-gene conditions. In the future, it is likely that whole-exome and whole-genome sequencing will be applied to prenatal genetic testing to allow identification of yet more genetic disorders. With advances in technology, the indications for testing have likewise evolved far beyond recommendations based solely on maternal age to include a more patient-centered view of the goals of prenatal testing.
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Affiliation(s)
- Mary E Norton
- University of California, San Francisco, San Francisco, CA.
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50
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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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