Desire to have children

Question

Hello,

My boyfriend and I (CF, 25 years old, 179cm, 67kg, FEV1: 90%) have been trying to get pregnant for two years and are now under treatment at a center for patients who wish to have children. However, the staff there has not been able to provide any (satisfactory) answers to some CF-specific questions: How likely is it that the fallopian tubes, which were previously checked for permeability, get blocked again and in which space of time could this happen? Is it possible that the egg’s or sperms’ passage gets blocked even though the tubes are clear?

Does a Sims-Huhner test (which doctors have refused so far) make sense even before insemination? Is there a similar test that can be carried out to check the tissue of the uterus and the fallopian tubes that is relevant for an insemination? Would the health insurance company cover the cost for an SH test? If not, how much would it cost?

Are there drugs that reduce the likelihood of getting pregnant? I am currently taking acetylsalicylic acid (expectorant), dornase alfa, sodium chloride (inhalation), flucloxacillin, and a vitamin compound (ADEK). Additionally, during times in which I can exclude a pregnancy, I occasionally inhale Tobramycin for two weeks.

[geographically specific inquiries were omitted in the translation]

Kind regards,
Sarah

Answer

Dear Sarah,

In order to be able to answer your questions to your satisfaction, we have consulted our gynaecologist from the board of experts. Nevertheless, it has to be stressed that it is impossible to give universal answers from the distance. To do that, it is very important to be in direct contact with the patient. We have, however, tried to answer your questions in the best way possible via the internet.

1. Fallopian tubes that have been diagnosed as permeable (which method was used for the diagnosis?) can get clogged anytime in case of an inflammation. Those inflammations may go unnoticed sometimes.

2. The transport of egg or sperm may be disturbed even if the fallopian tubes are clear. This, however, evades any particular diagnostics. It is generally conceivable and was suspected in the past (but never proven) that the passage gets affected in CF patients.

3. A Sims-Huhner test before insemination is unneccesary, since it only checks the reaction between sperm and cervical secretion, and in an insemination, the catheter is led past the cervical secretion into the uterus. There is no test that checks the tissue of the uterus or fallopian tubes.

4. Naturally, there are drugs that impede conception; however, it is highly unlikely that the drugs you specify here would do that (I am assuming you mean acetylcysteine, not acetylsalicylic acid?). Theoretically, acetylcysteine may modify all secretions; if it is justifiable to do so, I would recommend leaving it out.

5. The fundamental point to me, however, is whether a spermiogram of your partner actually exists. This is indispensable.

6. Have you taken any hormone tests? Do you have regular cycles? You are not underweight (at age 25, a height of 179cm and weight of 67kg equal a Body Mass Index of 20,91, which is normal), but perhaps it would make sense to check whether the hypothalamic-pituitary hormone distribution is affected in your case.

7. Cost: You should check that with your insurance company for your individual case.

8. Unfortunately, we cannot give you any addresses of centers for reproductive medicine, but we recommend checking with your respective CF center in this regard.

We hope we have been able to help you a bit with this.

Best wishes

Dr. A.-U. Stücker

16.02.2009