Desire to have children

Question

Dear Sir, dear Madam,

I am an 18-year-old woman. My boyfriend is almost 18 and has CF. He takes medication but has little to no complaints. We are professionally and financially both doing well and we would like to have a baby. I have two questions: I know that the chance to get pregnant naturally is rather small, but is it totally unthinkable? Or are there cases known where couples get pregnant naturally even when the man has CF? And also, sorry for bothering you with another question, from what age can you start with an IVF treatment? When my boyfriend is 18 soon, and we are both above 18, can we start IVF, then?
Thank you very much in advance for you answer.

Answer

Dear Madam,

Thank you for asking this question. As you’ve probably already read, most men with CF are not fertile. The reason is: the defective chloride channel leads to blocking of the spermatic ducts (vas deferens), so that the sperm cannot get from the testicle to the ejaculate. In medical terms this is called CBAVD (congenital bialteral aplasia of the vas deferens). However, male infertility is indeed not 100%. Especially in patients with milder disease, it is prudent to examin the seminal fluid for presence of sperm cells. If infertility of your partner is confirmed, the spermatozoa of your partner can be picked-up with a needle (TESA = testicular sperm aspiration). Since sperm taken directly from the testicle is insufficiently mobile, artificial insemination (just placing this sperm in the vagina/cervix of the woman) is not an option. The so called IVF technique (in vitro fertilization) is indeed needed. That means that the fertilization takes place in the lab. The sperm that was picked up can then be used for in vitro fertilization together with the female eggs that are also picked up by minor surgery. Then when the egg is fertilized, it is placed in the uterus.
An important additional factor is the genetic risk for your child. Your partner will for sure transmit a CF gene to the baby. It is important to check whether or not you are carrier of a CF gene. The most frequent mutations can be detected by blood sample. But even when these are not found, we cannot say for 100% certainty that you are not a carrier. But the chances that you are a carrier are very small. If you are not a carrier your children will not have CF. They will just carry the gene and can give the gene to their children.
In Belgium IVF is legally possible from the age of 18 on (age of consent). For more information, please contact the CF center where your partner is followed. They can also refer you to a fertility center.
We hope that this is a sufficient answer to your question.
Prof. Dr. M. Proesmans

04.11.2014