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Case Reports
, 17 (2), 209-216

Microdissection Testicular Sperm Extraction in Five Japanese Patients With Non-Mosaic Klinefelter's Syndrome

Case Reports

Microdissection Testicular Sperm Extraction in Five Japanese Patients With Non-Mosaic Klinefelter's Syndrome

Makoto Chihara et al. Reprod Med Biol.


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.

Keywords: Klinefelter's syndrome; azoospermia; infertility; intracytoplasmic sperm injection; pregnancy.


Figure 1
Figure 1
Microscopic findings of the testis in Case 5. Expanded seminiferous tubules (magnification: 25×) were unable to be identified and only fine, thin seminiferous tubules were recognized (indicated by an arrow). In the event that the seminiferous tubules were present, they were extremely few
Figure 2
Figure 2
Pathological findings in Case 5, with the partial deletion of azoospermia factor b. The testis shows extensive tubular hyalinization, nodular Leydig‐cell hyperplasia, and fibrosis. A few non‐hyalinized tubules contain only Sertoli cells

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