Infertility in Men and Women with Cystic Fibrosis

Due to the advances in medicine and technology there is an increased number of infertility causes known today. One of the major complications for those who suffer from cystic fibrosis is infertility. Both men and women affected by certain genetic disorders suffer from infertility. However, different individuals are affected differently by this syndrome. 97% of all men affected by cystic fibrosis are found to be infertile, but they do have the capacity to have babies through assisted reproductive technology (ART). Sperm is extracted from the fine tubules behind the testis, known as epididymis by the following procedures:

  1. Micro Epididymal Sperm Aspiration (MESA)

  2. Testicular Sperm Extraction (TESE)

  3. Percutaneous Epididymal Sperm Aspiration (PESA)

All the above mentioned medical procedures are executed under the effects of local anaesthesia.

Fertility in Men with Cystic Fibrosis

Around 97 to 98% of men suffering from Cystic Fibrosis are reportedly affected by issues of infertility. However, they can enjoy a normal sex live and can also become fathers with the help of assisted reproductive technology (ART).

Biology of Male Reproduction and CF

Before understanding the internal functionalities of male infertility due to cystic fibrosis, it is important to understand the biology of the male reproductive system. There are three primary parts in the male reproductive system. These are:

  1. The testicles

  2. The epididymis

  3. The vas deferens

The reproductive cells or sperm are formed inside the testicles. The sperm is stored in the tubes attached to the testicles, known as epididymis until they come out at ejaculation. The long tube connecting the epididymis to the ejaculatory ducts, known as the vas deferens, serves as a canal for the mature sperm to come through the penis during ejaculation. This occurs at the time of orgasm usually after sexual intercourse or masturbation.

Most men are infertile due to a blockage or sometimes absence of the sperm canal. This is known as Congenital Bilateral Absence of the Vas Deferens (CBAVD). Due to this absence it is hence not possible for the sperm to make in into semen. It means that it is impossible for the sperm to reach the egg and fertilize it naturally during sexual intercourse. Due to the absence of sperm in the semen, the man’s ejaculation becomes thinner and holds a lower semen volume.

Infertility and Sterility

It is important to understand infertility and sterility in order to understand the effects that CF can have on male reproduction. Since the vas deferens is found to be blocked or entirely missing, the sperm is restricted in it’s movement. As a matter of fact, the production of sperm in the testicles is normal in around 90% of all men with CF syndrome and CBAVD. That means most men with CF are capable of become biological fathers with the help of assisted reproductive technology (ART). The doctor usually refers such patients to an urologist for medical tests related to his infertility. Male reproductive experts prescribe tests to find out the reasons behind the infertility and how it might be cured.

The causes of CBAVD are not conclusively known even after newest technologies in the department of urology has been introduced. It is normally connected to Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene mutations. This causes troubles in the pancreas and lungs as well. CBAVD is considered to be developed by genetic patterns of the same type present in CF. it is very much necessary for men diagnosed with CBAVD to get tested for CF. Since CBAVD usually do not show any external symptoms in men, it allows them to have a satisfactory sex life. In fact, most men remain unaware of CF or CBAVD in them till the time they face trouble in conceiving a child.

Men with CF are mostly infertile. However, they still have some sperm content in their ejaculated fluid. Unless their infertility is confirmed by medical tests, they keep on using contraception to prevent any possibility of unplanned pregnancy.

The other condition in men caused due to CF is a rare type of infection called male candidiasis. This condition has symptoms like:

  1. Sores on the penis

  2. Irritation

  3. Itching

Infertility in Women with Cystic Fibrosis (CF)

Women affected with CF are recorded to have much thicker cervical mucus than others. This causes ovulation issues in them due to poor nutrition. Still, most women affected with CF are fertile and can conceive naturally. However, thicker levels of mucus make it harder for the sperm to penetrate properly to the cervix. Hence, the time taken to become pregnant is extended and successful conception is usually delayed.

Women with CF have all the regular hormonal functions. Their reproductive tracts are normal and are properly developed for sexual intercourse. However, women who suffer from CF usually experience other health issues related to the reproductive system.

It is important to remember that despite of having thicker cervical mucus and ovulation issues, women with CF are still fertile. Initiation of puberty or regular menstruation can be irregular or even delayed in some cases. Women with CF who are overweight might not suffer from compromised fertility but surely face many other physical barriers that makes it difficult to conceive naturally. Hence, regardless of the presence or severity of CF, women who are not ready to become mothers should use contraception to restrict the possibilities of an unplanned pregnancy.

Absent or Irregular Periods

Poor nutrition in women, low Body Mass Index (BMI) and irregular lung function diminishes the ability to regularly ovulate and menstruate. This is why women affected with CF experience absent or irregular periods. This mostly happens in case they are found to be underweight or malnourished. Women in their young ages experience delayed puberty due to the effects of CF.

It is important for all young women to report to the doctor in case they face issues of missed periods or infrequent ovulation. Proper guidance from a dietitian or CF experts will help them overcome the issues related to general health and nutrition problems.

Stress Incontinence

Some women might have experienced the unexpected release of urine splashes during sneezing or coughing. This happens due to stress incontinence in women as a result of issues related to her primary reproductive health. Women experiencing CF might suffer from weakened pelvic floor muscles, something that makes it harder to bear a child during pregnancy. Those women are advised to hire a gestational carrier for their childbirth. She can use her eggs and her spouse’s sperm to form the embryo externally in the laboratory, and get it introduced in a surrogate’s uterine. This procedure will help her embryo survive. In case she chooses to carry the child in her womb, there are greater chances of miscarriage or early labor.

Women with CF issues can undergo Kegel exercises to firm up her womb muscles and support the bladder. Regular exercising puts the contraction and relaxation in a regular sync. However, if the body is not entirely ready for a pregnancy, it is not wise to be rigid on the decision of carrying the child in the womb. Development in the IVF and surrogacy sector has opened new doors for aspiring parents. They can easily go through IVF treatment to obtain a healthy embryo and introduce it into a professional surrogate for successful gestation and delivery.