Infertility can be a complication for adults with cystic fibrosis. Men and women with cystic fibrosis CF usually produce normal levels of sex hormones such as progesterone, estrogen, and testosterone, and can, therefore, enjoy a normal sex life.
However, people with CF often face special challenges when it comes to building a family. Ninety-eight percent of men with CF are infertile. This blocked or missing vas deferens is one of the problems caused by the CFTR genetic mutation. Sexual desire and performance are generally normal. Males with CF also are four times more likely to develop fluid accumulation around the testes hydrocele , which can decrease how well the testes work.
There is also a fold increase in having an undescended testicle. Some produce a lower volume of sperm or no mature sperm. Men with CF who want to father children may be able to have their sperm extracted and used to fertilize an egg. The indications may be psychosocial in order to prevent serious injury to the mental health of the pregnant woman or medical. The only absolute contraindication to pregnancy is a pre-existing pulmonary hypertension with cor pulmonale; also chronic hypoxia could be considered a contraindication to pregnancy.
There are no clear indications about the FEV1 cut-off to recommend pregnancy termination. Burkholderia cepacia infection. Most pregnancies in CF end in spontaneous vaginal delivery. Caesarean section is indicated only in case of maternal or fetal sufferance, preferably with spinal anesthesia. Usually, failing lung function and hypoxia occur in patients with a significant low pre-pregnant lung function; persisting hypoxia and onset of headache are in these cases severe signs and could request oxygen support or non-invasive ventilation.
In peripartum, pain and anxiety can lead to hyperventilation and decrease in alveolar gas exchanges; hypoxia, hypercarbia, and respiratory acidosis occur rapidly in patients with compromised lung function.
An adequate analgesia should be performed, because it reduces pain, fear, and fatigue; oxygen support can be useful in case of desaturations. In the last few years, fertility issues increased significantly in our population, surely because of the significant improvement in prognosis and the easier access to the assisted reproduction treatments.
During the last 20 years, 12 of our male patients recurred to in vitro fertilization with sperm obtained by epididymal aspiration and in 6 cases had successful reproduction with twin pregnancy in 2 cases and in 1 case triplet pregnancy. All the newborns enjoyed good health and no recurrence of CF has been detected all the partners were tested for CFTR mutations before the conception. In the other six cases in vitro fertilization was not successful and one of these three patients decided to use heterologous fertilization by sperm donor, with a subsequent successful pregnancy.
In the same period four of our female patients recurred to in vitro fertilization with two successful pregnancies in one case twin pregnancy. Also in these cases the newborns enjoyed good health and no recurrence of CF has been detected all the partners were tested for CFTR mutations before the conception. In our population 12 of our patients 10 women and 2 men had spontaneous conceptions with 18 successful pregnancies.
Also in these cases no recurrence of the disease has been detected, even if in some cases the diagnosis of CF in these patients had been performed after the delivery and in most cases the partners had not been tested for CFTR mutations before the conception. Three of our female patients, after several attempts to become pregnant spontaneously, decided and obtained to adopt a child.
Actually, no literature is available about scrotal imaging in males affected by CF. Preliminary results seem to show an increased incidence of testicular and epididymal abnormalities in comparison to the general population, but in most cases these seem to be secondary to the obstruction of vas deferens [ FigureS 7 ,8,9].
US Figure of rete testis ectasia with structure inhomogeneities in a CF patient. US Figure of rete testis ectasia with structure inhomogeneities with a little epididymal cyst in a CF patient. US Figure of intradidymal cysts one with corpuscular content in a CF patient.
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Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. Downloaded: Introduction As the life expectancy of cystic fibrosis CF patients continues to increase, and more patients become adults with a chronic disease, researching the impact of this disorder on male and female infertility has become increasingly important.
Pathogenesis Cystic fibrosis transmembrane conductance regulator CFTR is a gene located on chromosome 7 7q Other genital abnormalities Genital abnormalities may develop early in CF, but in children these are less common than described in adults. Fertility management in men with CF Over the last 20 years, the relevant improvement in survival of CF patients and the concomitant development of new assisted conception methods have significantly increased the opportunities for these patients to become parents.
Assisted reproduction in men with CF 2. Counseling CF men and their partners, who want to start assisted reproduction treatments, need an adequate genetic, medical, and psychological counseling.
Sperm collection Sperm retrieval is a procedure used to obtain sperm for fertility purposes. The techniques of collection include: Percutaneous epididymal sperm aspiration PESA from the caput of the epididymis, usually simple to localize and good reservoir of sperm; aspiration is performed with fine needle after local anesthetization and is usually fast and well tolerated by the patient Microsurgical epididymal sperm aspiration MESA Percutaneous testicular aspiration TESA performed with local anesthetization Figure 2 as for PESA Testicular surgical biopsy Figure 3 Testicular sperm extraction TESE , an in vivo microdissection of testicular tubules finalized to the identification of normal tubules Figure 4 , suitable for an effective sperm collection.
Assisted reproduction treatments The first experience of in vitro fertilization with sperm obtained by epididymal aspiration was in [ 13 ]; in the next years, several experiences also in CBAVD patients have been reported [ 14 ]. Pathogenesis Despite CF has long been associated with female infertility, the underlying causes remain unclear.
Impact of pregnancy on CF The physiologic changes associated with pregnancy may contribute to increased morbidity and mortality risks for the mother in CF women. Risk factors The pregravid pulmonary function is clearly the greatest outcome predictor in CF women, but there are multiple clinical prognostic markers to consider.
Pancreatic insufficiency and diabetes mellitus In old literature, pancreatic insufficiency was considered as a major risk factor in pregnancy outcomes. Microbiological issues Burkholderia cepacia complex has been considered for several years a relative contraindication for pregnancy in CF, because this infection seemed to be related with a higher maternal mortality [ 30 ].
Pulmonary transplantation Limited cases of pregnancy after lung transplantation have been reported; most experience comes from renal transplantation. Management of pregnancy in CF women The management of pregnancy in CF requests necessarily a multidisciplinary approach. Counselling Counselling consists in helping the CF patient planning pregnancy and her partner to explain the risks of their decision, such as medical implications, treatment options, and also the impact of a toddler on the everyday life of a CF woman.
Medications during pregnancy Most drugs have not been tested on pregnant women. Each drug is classified to one category of safety: Drugs that have been used widely during pregnancy and are assumed safe for the fetus Drugs not known to cause harm to the human fetus but with insufficient experience to consider them safe. Lung function and infections CF women can become pregnant in all pulmonary disease stage, but the outcome for the mother and the newborn is closely related to lung function FEV1 predicted and clinical stability.
Physiotherapy If the pregnancy is planned, preconceptional period could represent a good opportunity to optimize the daily physiotherapy program. Nutrition Dietetic counselling is crucial in preconceptional period, because maternal nutritional state is one of the most important factors influencing outcomes for mother and infant. Skip to main content. Fertility in Men With CF While percent of men with cystic fibrosis are infertile, they can still enjoy normal, healthy sex lives and have biological children with the help of assisted reproductive technology ART.
In this article. Infertility in men with CF occurs because of an absence of the sperm canal. Your doctor can refer you to an expert in male reproduction, who can use medical tests to confirm whether you are infertile. The Biology of Male Reproduction and CF To understand the inner workings of infertility in men with cystic fibrosis, it is helpful to first understand the biology of the male reproductive system. Share this article. For this reason, pregnant women with CF are monitored much more regularly than women without cystic fibrosis.
For more information on women with cystic fibrosis and fertility, download our starting a family booklet. This is because the tube that carries sperm from the testicles to the penis called the vas deferens is either missing or blocked. However, it is possible for men with this CF-related problem to father biological children through fertility treatment. The lack of the vas deferens does not cause erectile dysfunction impotence.
For more information on men with CF and fertility, download our starting a family booklet. During IVF, an egg is removed from the woman's ovaries and fertilised with sperm in a laboratory.
The fertilised egg, called an embryo, is then returned to the woman's womb to grow and develop. For some people, adoption is their first preference for creating a family, while others turn to adoption having not been able to conceive their own child. The adoption process requires a series of suitability checks, including a health assessment.
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