Sexual Function and Clinical Features of Patients With Klinefelter's Syndrome With the Chief...

1942 MALE INFERTILITY

or combined male and female factor infertility. Interestingly, the prevalence of chromosomal abnormalities in this population biased towards male infertility was higher among the wives of these infertile men (5.5% versus 2.1%, respectively). Yoshida et al observed a slightly higher Prevalence (6.2%) of chromosomal abnormalities in a much larger patient population. However, the sperm chromosomal characteristics may not always be the same as those found in somatic Cells. Storeng et al observed a doubling of sex chromosome aneuploidy in sperm cells obtained from infertile men compared to fertile controls but the prevalence was only 1.5%. Clearly, this is not the end of the story, since chromosomal studies detect only gross changes in the genetic material. Genetic studies are required to detect more subtle but still significant genetic abnor- malities that may be present in infertile men and passed on to offspring via intracytoplasmic sperm injection.

Jonathan P. Jarow, M.D.

Sexual Function and Clinical Features of Patients With Klinefelter's Syndrome With the Chief Complaint of Male Infertility

A. YOSHIDA, K MIURA, K. NAGAO, H. HARA, N. ISHII AND M. SHIM, First Department of urology, Toho University School of Medicine, Tokyo, Japan

Int. J. Androl., 20 80-85, 1997 In this report, we present the overall sexual function and clinical features of patients with Klinefelter's

syndrome with the chief complaint of male infertility. The study consisted of 40 patients with a control group of 55 infertile non-azoospermic males with a normal 46,XY karyotype who visited the Reproduction Center of Toho University Hospital during the 5.5-year period between January 1991 and June 1996 with the chief complaint of male infertility. Among the 40 patients with Klinefelter's syndrome, 38 cases were pure 47=, one case was 47,XXY with a pericentric inversion of chromosome 9 and one case was a mosaic of 46,XY/47,XXY(2:28). Thirty-nine of these 40 patients were azoospermic and one (47,XXY) had severe oligoasthenozoospermia. The sexual finction of the patients was evaluated according to their responses to a preliminary questionnaire devised by our department. There was no significant difference in the fre- quency of sexual function disturbances between the patients with Klinefelter's syndrome and the control group (67.5% vs. 60.0%; ,y2 analysis; p = 0.454). The mean frequency of sexual intercourse per month in the patients with Klinefelter's syndrome was significantly higher than in the control group (4.4 2 2.8 vs. 3.3 2 1.6 Welch's t-test, p < 0.05). A possible explanation for this variation may lie in the fact that many of these patients were diagnosed with azoospermia prior to the administration of the questionnaire and may have wished to continue to have relations as a couple.

Editorial Comment: Klinefelter's syndrome (47Jann is the most common chromosomal cause of azoospermia. The extra X chromosome is derived equally from the mother and father of patients with classical Klinefelter's syndrome. In contrast, mosaicism is due to mitotic nondis- junction following fertilization. In this large series of 40 men all were azoospermic except for 1 who had a sperm count of less than 1 million per ml. Serum testosterone levels were within normal limits in half of this population. The most interesting finding was that Klinefelter's syndrome does not appear to have any significant adverse effect on sexual function compared to a control group despite that half of the patients have an abnormally low testosterone level. Therefore, testosterone therapy may have limited value in this patient population, since prior studies have already demonstrated that testosterone replacement does not prevent bone demi- neralization in men with Klinefelter's syndrome.

Jonathan P. Jarow, M.D.

Births After Intracytoplasmic Injection of Sperm Obtained by Testicular Extraction From Men With Nonmosaic Klinefelter's Syndrome

G. D. PALERMO, P. N. SCHLEGEL, E. S. SILLS, L. L. VEECK, N. ZANINOVIC, S. MENENDEZ AND Z. ROSENWAKS, Center for Reproductive Medicine and Infertility, Department of Obstetrics and Gynecology and James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center, New York, New York

New Engl. J. Med., 338 588-590, 1998 No Abstract