Background: Men with cystic fibrosis (CF) have
bilateral absence of the vas deferens causing an obstructive
azoospermia that is not amenable to surgical correction. Advances in
the field of reproductive medicine allow for the procurement of viable
sperm and facilitate fertilization and pregnancy in couples where the
man has CF.
Objectives: To describe patient anatomy
and semen characteristics and to determine the pregnancy rates of
couples in whom the male partner has CF and who have undergone
microsurgical epididymal sperm aspiration coupled with in
vitro technology, specifically intracytoplasmic sperm injection
Design: Retrospective analysis.
Setting: Clinical department of urology and two
reproductive medicine units.
married men with CF who were referred for infertility.
Interventions: History, physical examination, semen
analysis, transrectal and renal ultrasonography, CF mutation analysis,
and microsurgical sperm aspiration coupled with ICSI.
Results: All 13 men had low-volume azoospermia, absent
vasa, and aplasia/hypoplasia of the seminal vesicles. CF mutation
analysis was carried out in 11 of 13 men, and 9 of 11 were ΔF508
homozygous. Eight men underwent microsurgical sperm aspiration, and
their partners underwent one or more cycles of ICSI. Five couples
(62.5%) achieved a pregnancy, with four couples delivering (three sets
of twins and one singleton).
Conclusions: CF in men is
accompanied by bilateral vasal aplasia. The resultant obstructive
azoospermia can be treated quite successfully with a combination of
sperm aspiration and ICSI. It is important for physicians involved in
the care of men with CF to convey the message that prospects for
fatherhood are excellent with current technology.