Desire to have a child despite CF

Vraag

Dear expert advice,

Since more than a year my boyfriend and I concentrate on thinking about the topic "family planning". I do have CF, but being a competitive athlete I have a good lung function and also in other aspects I do not have any constraints. Nevertheless, I did not succeed in becoming pregnant yet.
The visits at my CF out patient clinic and my gynecologist have not been satisfying due to missing knowledge in this field: The CF ambulance has a lack of insights and information about gynecological issues and my gynecologist does not know much about Cystic Fibrosis. Thus, my CF doctor was able to give me the green light for a pregnancy as far as my health is concerned (my boyfriend's genetic test was also negative) and my gynecologist could not diagnose any organic impairment (I have a regular menstruation cycle and everything is okay as well). But until now nobody was able to tell me which possibilities there are to increase the fertility of CF patients.

My boyfriend currently undergoes a detailed check-up. Should everything be okay with him one can assume that my cervical mucus is impermeable to sperm. Is there a possibility to make it more fluid in order to raise the probability of becoming pregnant?

The next possibility I know is insemination. But at which point of time should this be tried? Which form of insemination is most promising? Which costs have to be calculated and are they maybe covered by the health insurance? Under which circumstances?

Many questions! I hope you can answer them and are looking forward to your message!

Best regards,
Sarah

Antwoord

Dear Sarah,

We asked our "CF gynecologist" Dr. Anja Stücker for help regarding answering your question. Here is the answer of Dr Stücker:

Unfortunately, your data are not complete so that I can only answer your questions in part. At first, it would be important to know your weight and body height in order to evaluate a potential underweight. The combination of competitive athletics and Cystic Fibrosis leads to a double risk of insufficient cycles or ovulations respectively. The check-up of your boyfriend's sperm is very important and should be done before all other measures are carried out. There is no possibility to make the cervical mucus more fluid. You are right when assuming that an insemination would be the next measure. Beforehand, you could make a test, however. The so called SH test ["Sims-Hühner-Test" or PCT "post coital test"] by means of which the cervix mucus including the sperm (mobility) in it is evaluated under the microscope after sexual intercourse at the right point of time (just before the ovulation). I would recommend this now after a regular spermiogram. Unfortunately, you do not write how old you are; this also gives the direction of the further action. If you are young (less than 30 years) and have only tried for a short period of time (approx. 6 months) to become pregnant (intercourse at the right point of time!), you should wait patiently for another half a year if the SH test is good.

Concerning the costs of insemination: In case the health insurance would take over some of the costs, you would have to calculate an own contribution of approx. 50 Euros; otherwise you will have to pay the whole amount on a private basis. If you will not become pregnant within 1-2 years (even with insemination) one would also have to consider that the transport of the ovum in the tube is possibly out of order due to the Cystic Fibrosis. In this case an in-vitro-fertilization might come into question for you.

In any case you should go to a gynecologist at an early stage in case of a positive pregnancy test in order to exclude a tubal pregnancy.
Finally, let me recommend you to introduce yourself at a center for reproduction medicine, for example at our center, if you like (University Hospital Frankfurt, Center for Gynecology and Obstetrics).

Best regards
Dr. med. A.-U. Stücker

I hope that the answers of Dr. Stücker have been helpful for you and wish you all the best.

Dr. C. Smaczny

23.04.2008