NEW research offers important clarity for patients with nonmosaic Klinefelter syndrome, addressing a long-standing debate about whether surgical sperm retrieval should occur early in adolescence or can be safely postponed. Stable Retrieval Success Across Adolescence and Adulthood emerges as the central message of this comprehensive meta-analysis, which pooled data from 48 studies involving 2,815 individuals with 47,XXY Klinefelter syndrome.
Investigators report a median sperm retrieval rate of 44%, with no significant difference between adolescents and adults, 45% versus 42%, respectively, challenging assumptions that puberty represents a narrow window for successful testicular sperm extraction.
Evidence Shows No Early-Intervention Advantage
Through analysis of adolescent cohorts (mean age <20 years), the authors found retrieval outcomes comparable to those of reproductive-age adults. Although groups with successful sperm retrieval were, on average, slightly younger than those with failed retrievals, this difference (2.8 years on average) did not translate into a clinically meaningful advantage for early intervention.
Potential Impact of Advanced Age was noted. However, although not statistically significant, a subtle downward trend in retrieval success appeared after age 40, hinting that very late procedures may be less favourable.
Beyond retrieval metrics, 22 studies reported live birth rates, with a median rate of 11.1%, reflecting expected attrition across sperm extraction, assisted reproduction, and embryo development. Reassurance for Family-Building Decisions is therefore a key takeaway.
Implications for Fertility Planning in Klinefelter Syndrome
The findings support counselling Klinefelter syndrome patients that delaying surgical retrieval into mid-adulthood does not reduce their likelihood of obtaining sperm for assisted reproduction or achieving biological parenthood. Only after approximately age 40 might outcomes begin to decline, and even then, the evidence remains preliminary.
Overall, the study provides timely guidance for clinicians and patients navigating fertility planning, underscoring that urgency for adolescent sperm retrieval is unwarranted and that reproductive autonomy can be preserved well into adulthood.
Reference
Momtazi-Mar LBS et al. Klinefelter syndrome sperm retrieval meta-analysis. Fertil steril. 2025;124(6):1223-34.
