Working...
ClinicalTrials.gov
ClinicalTrials.gov Menu
Trial record 1 of 30 for:    "klinefelter syndrome"
Previous Study | Return to List | Next Study

Fertility Assessment in Patients With Klinefelter Syndrome

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT02461303
Recruitment Status : Terminated (Unable to recruit the anticipated number of subjects for this study)
First Posted : June 3, 2015
Last Update Posted : July 24, 2018
Sponsor:
Information provided by (Responsible Party):
Kyle Orwig, University of Pittsburgh

Tracking Information
First Submitted Date May 26, 2015
First Posted Date June 3, 2015
Last Update Posted Date July 24, 2018
Actual Study Start Date January 7, 2016
Actual Primary Completion Date December 12, 2017   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures
 (submitted: October 20, 2017)
Presence of sperm in semen. [ Time Frame: On average once a year until the participant turns 26 ]
Participants will provide at least one semen sample. The presence of sperm will be analyzed. Participants will also be given the opportunity to have their semen analysed for the presence of sperm once a year. Participants will be followed until they reach age 26.
Original Primary Outcome Measures
 (submitted: May 29, 2015)
Presence of sperm in urine or semen. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
Participants will provide urine samples 1-2 times a year at the time of their routine visit with the endocrinologist. The presence of sperm will be analyzed. Participants will also be given the opportunity to have their semen analysed for the presence of sperm 1-2 times a year at the time of their routine visit with the endocrinologist. Participants will be followed until they reach age 26.
Change History Complete list of historical versions of study NCT02461303 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures
 (submitted: October 20, 2017)
  • Longitudinal correlation of developmental and endocrine parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1 time a year for an average of 7.4 years ]
    Participants will be followed until they reach age 26. Thereafter, patients will be contacted once a year via phone to asses fertility/infertility issues and over all health.
  • Correlation of developmental parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure height.
  • Correlation of developmental parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure weight.
  • Correlation of developmental parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure body proportions.
  • Correlation of developmental parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure Tanner stages.
  • Correlation of developmental parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will examine the presence of gynecomastia.
  • Correlation of developmental parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure and bilateral testicular size.
  • Correlation of endocrine parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure testosterone (T).
  • Correlation of endocrine parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure luteinizing hormone (LH)
  • Correlation of endocrine parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure follicle-stimulating hormone (FSH).
  • Correlation of endocrine parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure serum anti-Mullerian hormone (AMH).
  • Correlation of endocrine parameters with the presence or absence of sperm in semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure inhibin B.
Original Secondary Outcome Measures
 (submitted: May 29, 2015)
  • Longitudinal correlation of developmental and endocrine parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be followed until they reach age 26. Thereafter, patients will be contacted once a year via phone to asses fertility/infertility issues and over all health.
  • Correlation of developmental parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure height.
  • Correlation of developmental parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure weight.
  • Correlation of developmental parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure body proportions.
  • Correlation of developmental parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure Tanner stages.
  • Correlation of developmental parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will examine the presence of gynecomastia.
  • Correlation of developmental parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure and bilateral testicular size.
  • Correlation of endocrine parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure testosterone (T).
  • Correlation of endocrine parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure luteinizing hormone (LH)
  • Correlation of endocrine parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure follicle-stimulating hormone (FSH).
  • Correlation of endocrine parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure serum anti-Mullerian hormone (AMH).
  • Correlation of endocrine parameters with the presence or absence of sperm in urine and semen samples. [ Time Frame: 1-2 times a year for an average of 7.4 years ]
    Participants will be scheduled for a routine visit with the endocrinologist 1-2 times a year. At each visit, the endocrinologist will measure inhibin B.
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title Fertility Assessment in Patients With Klinefelter Syndrome
Official Title Non-Invasive Methods to Maximize Fertility in Peri-Pubertal Patients With Klinefelter Syndrome
Brief Summary

Klinefelter syndrome is characterized by primary testicular failure and progressive infertility. The objective of this study is to determine if sperm are present and can be observed in semen samples of adolescent and young adult Klinefelter patients and to determine whether the presence of sperm correlates with physical and/or clinically obtained hormone measures of pubertal development.

This study was designed in order to answer the following questions:

  1. Is it possible to retrieve sperm for cryopreservation from semen samples of adolescent and young adult Klinefelter patients?
  2. Does the presence of sperm correlate with the physical and/or endocrine measures that are assessed during routine clinical evaluations of pubertal development in the KS patient population?
  3. If sperm retrieval is possible, what is the optimal age at which sperm retrieval should be attempted?
Detailed Description

Klinefelter Syndrome (KS) is a genetic condition in boys and men that results from having two X chromosomes and one Y chromosome. The incidence of the 47, XXY karyotype that defines the disorder ranges from 1:500 to 1:1000 in newborn males. The sexual development and fertility phenotypes of Klinefelter's syndrome include azoospermia (absence of sperm in the ejaculate), small firm testes, gynaecomastia (enlargement of breast tissue), low testosterone levels, and elevated follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels that can have an important impact on the quality of life for these patients. Beginning with puberty, testicular biopsies from Klinefelter patients progressively show a degenerated testicular environment with Sertoli-cell-only tubules, sclerotic or hyalinized tubules, and interstitial Leydig cell hyperplasia. Nevertheless, scattered areas with focal spermatogenesis can be seen in Klinefelter men, and assisted reproductive techniques now offer hope for patients who wish to father their own biological children. In these cases, a surgical sperm recovery procedure called testicular sperm extraction (TESE) is performed to extract sperm for in vitro reproductive methods. Success rates for testicular sperm extraction in Klinefelter patients are consistently above 50% (50 - 72%) and are similar to the success rates reported for TESE in azoospermic patients without Klinefelter syndrome. Pregnancy rates and life births after intracytoplasmic sperm injection (ICSI) are similar in couples with or without KS, and babies fathered by KS patients have a normal karyotype. Previous studies in adult KS patients reported that sperm recovery rates were significantly lower after the age of 35. Therefore, it was suggested that surgical sperm recovery in younger (possibly pubertal) boys should be considered as an option to maximize the opportunity to preserve their fertility before becoming sterile. However, there is considerable debate about the benefit of early invasive fertility intervention for KS patients.

The standard, non-invasive and safe way to obtain and analyze sperm production and quality in normal post-pubertal males is to obtain a semen sample by masturbation. It is currently unknown when spermatogenesis starts in boys with KS, and if sperm could be detected by semen analysis in early puberty. In this proposal, the investigators aim to determine if non-invasive methods during puberty could be useful to assess the reproductive potential of KS patients, and to possibly cryopreserve sperm from these patients for future use with well-established assisted reproductive techniques like in vitro fertilization with ICSI (intra cytoplasmic sperm injection).

Although this will be a sensitive topic for adolescent patients with KS and their parents, it is essential to begin the conversation regarding fertility preservation. Indeed, most parents and patients have questions regarding future fertility. This study has a secondary benefit in that it provides an ideal opportunity to educate the affected males and their families about the long-term effects of KS on their fertility and the availability of reproductive technologies to help with fertility. Similar discussions are becoming increasingly common (standard of care) for cancer patients who are at risk for infertility due to their disease or oncologic treatment.

It is currently unknown when spermatogenesis starts in boys with KS. While it seems to be commonly accepted that there is a progressive depletion of germ cells in the testes of KS patients after the onset of puberty, the data to support this notion are equivocal due to small patient populations, lack of controls and absence of longitudinal data.

In addition, the standard therapy for boys with KS is testosterone replacement therapy to trigger entry and progression of puberty characterized by the development of secondary sexual characteristics, bone maturation, and continued linear growth. However, testosterone supplementation also suppresses spermatogenesis (if present) through negative feedback on the hypothalamus-pituitary-gonadal axis. Some argue that any intervention to preserve fertility for KS patients should ideally precede hormone replacement therapy. However, in one study it was proposed that topical testosterone therapy might not negatively affect spermatogenesis in adolescent KS patients. The risks and unknowns of invasive surgical procedures like TESE for boys have to be carefully weighed against the possible benefits for this unique patient population. For these reasons, the investigators propose that non-invasive methods would be appropriate to retrieve sperm and are essential to gain insights about the initiation and decline of spermatogenesis in KS patients.

In this study, the investigators will analyse if sperm can be found in semen of Klinefelter patients during puberty and early adulthood. Participants will be followed until they reach age 26. During the time of their study participation, participants will provide at least one semen sample.

Study Type Observational
Study Design Observational Model: Case-Only
Time Perspective: Other
Target Follow-Up Duration Not Provided
Biospecimen Retention:   Samples With DNA
Description:
Semen samples
Sampling Method Non-Probability Sample
Study Population Adolescent and young adults males who are proven to have Klinefelter Syndrome based on prior chromosome analysis (47,XYY).
Condition Klinefelter Syndrome
Intervention Other: Counseling
Subjects will be counseled on the impact of KS on the reduced fertility potential, and about providing a semen sample for semen analysis. Semen analysis is the gold standard for fertility preservation in adult patients, but is only rarely considered by post-pubertal adolescent and young adult patients and their families. Only the semen analysis parameters will be used by the study for the comparison with physical and endocrine measures to assess whether spermatogenesis in these patients coincides with pubertal development. All potential frozen samples will be stored for the patient's future use, and samples will not be used for research experiments.
Study Groups/Cohorts Not Provided
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status Terminated
Actual Enrollment
 (submitted: July 20, 2018)
6
Original Estimated Enrollment
 (submitted: May 29, 2015)
60
Actual Study Completion Date December 12, 2017
Actual Primary Completion Date December 12, 2017   (Final data collection date for primary outcome measure)
Eligibility Criteria

Inclusion Criteria:

  • males between the ages of 12 and 25
  • diagnosed with mosaic or non-mosaic Klinefelter's Syndrome
  • having bilaterally descended testes
  • not having had a febrile illness within 3 months of enrollment.

Exclusion Criteria:

  • previous treated with gonadotoxic chemotherapeutic or radiation regimen.
  • psychological, psychiatric, or other conditions which prevent giving fully informed consent.
Sex/Gender
Sexes Eligible for Study: Male
Ages 12 Years to 25 Years   (Child, Adult)
Accepts Healthy Volunteers No
Contacts Contact information is only displayed when the study is recruiting subjects
Listed Location Countries United States
Removed Location Countries  
 
Administrative Information
NCT Number NCT02461303
Other Study ID Numbers PRO15030141
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement Not Provided
Responsible Party Kyle Orwig, University of Pittsburgh
Study Sponsor University of Pittsburgh
Collaborators Not Provided
Investigators
Principal Investigator: Kyle Orwig, PhD University of Pittsburgh
PRS Account University of Pittsburgh
Verification Date July 2018