Abstract
Cystic fibrosis is a life-threatening disease. Only recently has the prognosis improved. In the male patient there is an almost invariable absence or maldevelopment of the vas deferens, creating a situation of obstructive azoospermia. Consequently, their fertility potential has been considered nonexistent. Having gained experience in microscopic epididymal sperm aspiration coupled with the advanced reproductive technologies for the treatment of congenital absence of the vasa, we sought to extend this treatment option to the male cystic fibrosis population. An Indian male with clinically evident and genetically confirmed cystic fibrosis underwent microscopic retrieval of epididymal sperm. The anatomy of the epididymis and the quality of sperm obtained were similar to those patients with congenital absence of the vas deferens. After appropriate spousal genetic testing, superovulation, and transvaginal oocyte retrieval, in vitro insemination of sperm was performed. Fifty percent of the oocytes were subjected to partial zona dissection and a single embryo resulted. Subsequent to transfer, no conception was realized but the effort expanded the clinical usefulness of microscopic epididymal sperm aspiration. This should open up an avenue of treatment for couples in whom only the most dire predictions for fertility have been made to date.
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Kerem E, Corey M, Kerem B-S, Rommens J, Markiewicz D, Levinson H, Tsui L-C, Durie P: The relation between genotype and phenotype in cystic fibrosis—Analysis of the most common mutation (ΔF508). N Engl J Med 1990;323:1517–1522
Holsclaw DS, Perlmutter AD, Jockin H, Shwachman H: Genital abnormalities in male patients with cystic fibrosis. J Urol 1971;106:568–574
Stern RC, Boat TF, Doershuk CF: Obstructive azoospermia as a diagnostic criterion for the cystic fibrosis syndrome. Lancet 1982;June 19:1401–1404
Temple-Smith PD, Southwick GJ, Yates CA, Trounson AD, de Kretser DM: Human pregnancy by in vitro fertilization (IVF) using sperm aspirated from the epididymis. J Vitro Fert Embryo Transfer 1985;4:298–303
Silber SJ, Ord T, Balmaceda J, Patrizio P, Asch RH: Congenital absence of the vas deferens: The fertilizing capacity of human epididymal sperm. N Engl J Med 1990;323:1788–1792
Cohen J, Malter H, Wright G, Kort H, Massey J, Mitchell D: Partial zona dissection of human oocytes when failure of zona pellucida penetration is anticipated. Hum Reprod 1989;4:435–442
Blanck RR, Mendoza EM: Fertility in a man with cystic fibrosis. JAMA 1976;235:1364
Tuassig LM, Lobeck CC, di Sant'Agnese PA, Ackerman DR, Kattwinkel J: Fertility in males with cystic fibrosis. N Engl J Med 1972;287:586–589
Seale TW, Flux M, Rennert OM: Reproductive defects in patients of both sexes with cystic fibrosis: A review. Ann Clin Lab Sci 1985;15:152–158
Matthews LW, Drotar D: Cystic fibrosis—A challenging long-term chronic disease. Pediat Clin No Am 1984;31:133–152
Kaplan E, Shwachman H, Perlmutter AD, Rule A, Khaw K-T, Holsclaw DS: Reproductive failure in males with cystic fibrosis. N Engl J Med 1968;279:65–69
Reiter EO, Stern RC, Root AW: The reproductive endocrine system in cystic fibrosis. Am J Dis Child 1981;135:422–426
Oates RD, Oskowitz SP, Krane RJ: Epididymal sperm aspiration (ESA) in conjunction with gamete intrafallopian transfer (GIFT) to achieve pregnancy. Presented at American Urological Association Annual Meeting, New Orleans, La. May, 1990
Olar TT, La Nasa J, Dickey RP, Taylor SN, Curole DN: Fertilization of human oocytes by microinjection of human sperm aspirated from the caput epididymis of an individual with obstructive azoospermia. J Vitro Fert Embryo Transfer 1990;7:160–164
Collins FS, Riordan JR, Tsui L-C: The cystic fibrosis gene: Isolation and significance. Hosp Pract 1990;Oct 15:47–57
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Oates, R.D., Honig, S., Berger, M.J. et al. Microscopic epididymal sperm aspiration (MESA): A new option for treatment of the obstructive azoospermia associated with cystic fibrosis. J Assist Reprod Genet 9, 36–40 (1992). https://doi.org/10.1007/BF01204112
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DOI: https://doi.org/10.1007/BF01204112