Klinefelter Syndrome (KS) is characterized by the presence of an extra X chromosome. It was first diagnosed in 1942 in a group of azoospermic men. KS is the most common chromosomal abnormality encountered in infertile men and accounts for more than 10% of the causes of azoospermia. Men who are azoospermic may still father children via testicular sperm extraction followed by intracytoplasmic sperm injection (ICSI).
Until 1996, men with Klinefelter syndrome were considered infertile. Since then, however, developments in microsurgical techniques and advances in artificial reproductive technologies (ART) have enabled over 50% of men with Klinefelter syndrome to sire their own children. Success has been achieved through a combination of microsurgical testicular sperm extraction (TESE) and the use of freshly retrieved sperm for in-vitro fertilization (IVF). TESE is the process of removing a small portion of testicular tissue under local anesthesia and extracting the few viable sperm present in that tissue for intracytoplasmic sperm injection (ICSI). Intracytoplasmic sperm injection (ICSI) has offered XXY men an increased chance to father a child. A study of 42 men with Klinefelter syndrome revealed a sperm retrieval rate of 72% per testicular sperm extraction attempt, with adequate sperm for ICSI found in 69% of subjects (29 of 42 men). Thus, TESE and ICSI may be considered for males with azoospermia and Klinefelter syndrome.
Men with Klinefelter mosaic cell lines may have viable sperm in their ejaculate and hence be able to father a child without assisted reproductive technology.
A literature review including 13 studies and 373 men with KS demonstrated an overall success rate for SSR of 44% with a range of 16–60% and another review including 19 studies and 668 men with KS revealed a positive SSR rate of 49.6% with a range of 16–69%. The success rate was higher for micro-TESE [55% (61/110)] compared to TESE [42% (95/228)]. On the other hand a more recent systematic review and meta-analysis of 37 studies investigating sperm recovery in 1,248 men with KS using a variety of SSR techniques demonstrated similar retrieval rates for micro-TESE [45 (38; 52)%] compared to TESE [43 (35; 50)%] and an overall rate of 44 (39:48)% (22). There was also no difference whether the retrieval was a unilateral or bilateral surgical procedure.
Iranian surgery is an online medical tourism platform where you can find the best fertility specialists in Iran. The price of micro-TESE procedure in Iran can vary according to each individual’s case and will be determined by an in-person assessment with the doctor.
For more information about the cost of Microsurgical Testicular Sperm Extraction in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number 0098 901 929 0946. This service is completely free.