A 24-year-old man comes to the office complaining of infertility.  He and his wife have been trying to conceive for the last 18 months.  Medical records of his wife showed no abnormalities.  The patient doesn't smoke and takes no medications.  Height is 185 cm and weight is 77 kg.  Heart and lung sounds are normal.  There is bilateral gynecomastia and bilateral descended firm testes.  The lower extremities appear abnormally long. His karyotype evaluation shows 47, XXY consistent with Klinefelter syndrome.