(257) SHOULD ALL AZOOSPERMIC KLINEFELTER MEN UNDERGO ENDOCRINE STIMULATION THERAPY PRIOR TO MICROSURGICAL TESTICULAR SPERM RETRIEVAL (mTESE)?

Abstract Objectives Klinefelter syndrome (47XXY) is a common genetic cause of non obstructive azoospermia (NOA) and hypogonadism. MTESE has provided potential for these men to experience fatherhood although surgical sperm retrieval (SSR) rates are low. This study aims to evaluate the role of endocrine stimulation therapy prior to mTESE in men with NOA secondary Klinefelter syndrome (KS). Methods Retrospective study on KSmen who underwent mTESE with-or-without prior endocrine stimulation therapy. Demographic data, previous exogenous testosterone therapy, duration and type of stimulation, pre-and post-stimulation hormone levels (T, FSH, LH), SSR, average Johnsen score and total number of vials cryopreserved were all recorded. The success criteria for mTESE was defined as at least 1 vial of viable sperm retrieved. Results 64KSmen underwent mTESE out of which 39men received prior endocrine stimulation therapy for a mean duration of 11.8±8.5month. Thirty patients received human chorionic gonadotropin and 9 clomiphene. The mean pre-stimulation serum testosterone level was 6.1±3.7nm/L increased to 9.4±6.9nm/L post-stimulation. Testosterone levels significantly increased after endocrine stimulation (6.1±3.7nm/Lvs9.8 ± 6.9nm/L, p<0.001) with mean change in serum testosterone (ΔT) of 4.9nm/L. In the stimulated Johnsen score was 1.6±0.8 and successful sperm retrieval (SSR) rate 28.2%(17/39). The 25 men who did not received stimulation had pre-mTESE serum Testosterone of 10.5±4.9, Johnsen score of 1.6 the average Johnsen score 1.5±6 and SSR of 28%(7/18). Comparing men who had successfulvs unsuccessful mTESE - higher level of serum T seemed to correlate with successful sperm retrieval (p: 0.036). Among men who received endocrine stimulation therapy ΔT before and after stimulation did not correlate with successful outcome. Age had no affect success. Conclusions Our study shows that there is a significant improvement of serum T concentration following endocrine stimulation therapy in KSmen. Overall the hormonal stimulation seems not to be related to a higher success rate of mTESE but our data do suggest positive correlation between higher level of preoperative serum Testosterone and successful mTESE in patient suffering from KS. Conflicts of Interest None