Fertility in men with cystic fibrosis - An update on current surgical practices and outcomes

Background: Men with cystic fibrosis (CF) have bilateral absence of the vas deferens causing an obstructive azoospermia that is not amenable to surgic al 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 de termine the pregnancy rates of couples in whom the male partner has CF and who have undergone microsurgical epididymal sperm aspiration coupled with i n vitro technology, specifically intracytoplasmic sperm injection (ICSI). Design: Retrospective analysis. Setting: Clinical department of urology and two reproductive medicine units . Patients: Thirteen married men with CF who were referred for infertility. Interventions: History, physical examination, semen analysis, transrectal a nd renal ultrasonography, CF mutation analysis, and microsurgical sperm asp iration coupled with ICS. Results: All 13 men had low-volume azoospermia, absent vasa, and aplasia/hy poplasia of the seminal vesicles. CF mutation analysis was carried out in 1 1 of 13 men, and 9 of 11 were Delta F508 homozygous. Eight men underwent mi crosurgical sperm aspiration, and their partners underwent one or more cycl es of ICSI. Five couples (62.5%) achieved a pregnancy, with four couples de livering (three sets of twins and one singleton). Conclusions: CF in men is accompanied by bilateral vasal aplasia. The resul tant obstructive azoospermia can be treated quite successfully with a combi nation of sperm aspiration and ICSI. It is important for physicians involve d in the care of men with CF to convey the message that prospects for fathe rhood are excellent with current technology.