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Some 95–98% of men with cystic fibrosis (CF) have azoospermia because of aplasia of the vasa deferentia. Pregnancy may be achieved, however, in nearly two-thirds of couples in which the man has CF by use of microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection. Several studies have suggested that adolescents and young men with CF need, and want, more information about their sexual and reproductive health. A report from Melbourne, Australia (
) has emphasised the point.
Questionnaires were sent to 125 eligible men (not receiving palliative care) who attended the regional adult CF clinic and 94 were completed and returned. The responders were aged 18–54 years (mean 30.5 years) and 58 were married or in a relationship. Sixteen had had a lung transplant. Only one respondent (aged 19 years) did not know about the effect of CF on male fertility but knowledge was often incomplete. Most had first heard about the infertility from CF clinic staff at an average age of about 16 years but they felt they would like to have been informed earlier. Seventeen men reported having been very upset when first told about fertility problems and those first told when older were more likely to be upset.
Forty-nine men had had semen analysis, all at age 24 years or older. Three-quarters of respondents thought that semen analysis should be offered at 17–18 years. As adolescents, some men had been uncertain about the difference between infertility and impotence and a substantial number had concluded that they would have no need for contraception. Sixty-two men said they would like more information about reproductive options. Seventeen men had a total of 27 children though only seven were biological fathers, one by natural conception and six by use of micro-epididymal sperm aspiration. Sixty-five of the 77 without children reported that they would like to become fathers at some time.
Reproductive options should be discussed with older teenage males in CF clinics and semen analysis should be offered.