Sertoli-Cell-Only Syndrome Treatment & Management

Updated: Jan 15, 2019
  • Author: Edward David Kim, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Treatment

Approach Considerations

No effective medical therapy exists for Sertoli-cell-only (SCO) syndrome. If the couple is considering in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), consultation with a reproductive endocrinologist is necessary.

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Surgical Care

Testicular sperm extraction (TESE) may be offered to couples considering IVF/ICSI. At specialty centers, as many as 20%-40% of men with SCO syndrome may be identified as having isolated foci of spermatogenesis within the testis; however, the option of using donor sperm must be discussed with the couple. At most centers, sperm recovery rates are much lower.

TESE is a testis biopsy performed with the intent of finding mature sperm within the seminiferous tubules. Multiple and extensive biopsies are typically required when SCO syndrome is present. Because spermatogenesis may be patchy within the testis, occasional pockets of isolated sperm production may be identified, even when the predominant histopathology finding is SCO syndrome.

Microsurgical TESE (mTESE) may be performed at some specialty centers, offering improved chances of successful sperm extraction with a decreased risk of morbidity.

In patients with SCO syndrome with pockets of sperm production, repair of a concurrent varicocele can increase the chances of subsequent successful surgical retrieval of sperm.

A meta-analysis of the outcomes of 37 trials enrolling a total of 1248 men with Klinefelter syndrome who underwent TESE found that  sperm retrieval rates per TESE cycle of ranged from 39-48%. Similar results were observed for in both conventional TESE (35-50%) and mTESE (38-52%). Overall a total of 218 pregnancies occurred after 410 ICSI cycles for a pregnancy rate of 43%. Meta-regression analysis showed that age; testis volum;e and FSH, LH, and testosterone levels at enrollment had no effect on the final sperm retrieval or pregnancy rate. [15]

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