Fertility in men with cystic fibrosis assessment, investigations and management.

Congenital absence of the vas deferens is the primary cause of azoospermia in men with cystic fibrosis [CF]. In some there may also be an abnormality in spermatogenesis and sperm maturation. Despite these abnormalities, sperm capable of fertilizing mature oocytes in vitro can be extracted from the majority of men with cystic fibrosis. Experience at Westmead Hospital over the last 12 years has shown mature spermatozoa can be obtained by a simple percutaneous needle aspiration of the epididymis or testis after local anaesthetic has been infiltrated around the spermatic chord. This procedure has been successfully repeated up to six times in some men. Epididymal or testicular sperm can be used to fertilize mature oocytes by intracytoplasmic injection in vitro. All offspring resulting from such procedures will be CF carriers and to reduce the probability this will result in a child with CF it is important the female partner has pre-treatment screening for CF mutations.