Introduction To develop a preliminary, decision-making protocol capable of predicting sperm retrieval success in non-mosaic Klinefelter's syndrome (KS) patients. Main outcome was to identify predictors of successful sperm retrieval and to build a decision-making protocol capable of predicting this success by assessing several variables including age, testicular volume and pre-operative hormonal responses. Methods A retrospective cohort study included all men with non-mosaic KS who were treated with recombinant hCG and then underwent microdissection testicular sperm extraction (micro-TESE) between December 2019 and March 2023. Results Thirty-eight patients who were treated medically with rec-hCG prior to their micro-TESE were included. Sperm was retrieved successfully from 28 patients (73.7%). Initial testosterone differences between the groups were small and not significant, the mean pre-op (post hormonal treatment) testosterone between the two groups was significant (P =0.001). We then built a decision making tree, in which Testosterone change was the primary determining factor for successful sperm retrieval, testicular volume was a contributory secondary variable, and age was a tertiary consideration in cases of low testicular volume. Using this model, we observed the highest success rates (97%) in men with testosterone change of 9 nmol/l or more and testicular volume of 3 cc or more. on the other hand, men with no testosterone change with hormonal treatment, low testicular volume who were 25 years old or more had a success rate of only 63%. Conclusion This study proposes a preliminary, decision-making protocol capable of predicting sperm retrieval success in non-mosaic KS patients. This model can be used as part of an individualized counselling approach. External validation is essential to corroborate our preliminary results.
Barak et al. (Thu,) studied this question.