Assisted Reproductive Technology (ART) is a collection of techniques that help in achieving pregnancy by manipulating eggs, sperm, and embryos.

While ART mostly uses the couple’s own sperm and eggs, it also includes the use of donor sperm, eggs, or embryos in the event that the patients’ sperm or eggs are not suitable.

Counseling usually is offered to both partners before undergoing ART to make them aware of the potential outcomes and associated risks.

Cystic fibrosis and fertility

Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the CFTR gene. This results in the buildup of thick, sticky mucus in organs such as the lungs, pancreas, intestines, and reproductive organs.

The normal CFTR protein helps maintain proper salt content in various organs by regulating the movement of chloride ions in and out of cells. The movement of chloride ions establishes a salt gradient that is needed for water balance in the cell and consequently, enables secretion of thin, watery mucus. In male reproductive organs such as the testes, this watery mucus facilitates the movement of sperm cells.

The thick mucus in CF affects reproductive function in both men and women, but it usually is more of an issue for men because most men with the disease also have a condition called congenital bilateral absence of vas deferens (CBAVD) in which the vas deferens (the duct that helps transport sperm) is completely absent.

Types of ART for CF

There are about eight widely recognized ART techniques covering most reproductive issues, but the ones most helpful for those diagnosed with CF are in-vitro fertilization (IVF) and intrauterine insemination (IUI). This usually is preceded by the surgical retrieval of sperm from the man. The exact procedure to be used for sperm retrieval will be determined by the urologist, but the most common methods are microscopic epididymal sperm aspiration (MESA) and testicular sperm aspiration (TESA).

Once the sperm is extracted, the woman is prepared for IVF or IUI. This usually involves the use of medications to stimulate ovulation. The extracted sperm can be used immediately for ART, or frozen to be used at a later date.

In-vitro fertilization (IVF)

In-vitro fertilization (IVF) is the process of allowing the sperm to fertilize the egg outside a woman’s body in a culture dish. Usually, the fertility specialist will prescribe tests to ensure that both the man and woman can produce sperm or eggs.

The fertility team closely monitors the ovulation process and eventually  administers a “trigger shot” of human chorionic gonadotropin (hCG) hormone to help the eggs mature; then they are collected using a fine needle.

The eggs are mixed with the sperm collected earlier in a culture dish to allow fertilization and formation of the embryo. The embryo that is formed is implanted back into the uterus of the woman. Additional embryos, if any, can be frozen for later use.

Women who are CF carriers (i.e., who have one copy of the mutated CFTR gene) can undergo IVF irrespective of their carrier status. A recent study has shown there is no significant difference in stimulation response and cycle outcome between CFTR gene mutation carriers and non-carriers.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI), also known as artificial insemination, is the process of delivering sperm cells into the uterus using a catheter to increase the chances of fertilization. Women with CF usually secrete thickened cervical mucus that obstructs the passage of the sperm. IUI may be helpful for such patients.

IUI is less invasive than IVF and is especially useful when sperm count is low. IUI can be performed without having to take medications, but fertility specialists may offer ovulation-stimulating drugs before starting the procedure.

Once the specialist determines the eggs are mature, sperm collected from the man is concentrated and delivered into the uterus via a catheter.

The procedure causes minimal discomfort and lasts only a few minutes.

Donor sperm, eggs, and embryos

Sometimes, patients who are not able to produce viable sperm or eggs, or who are concerned about passing on CF to future generations, can opt to conceive using donor sperm, eggs, or embryos. Genetic counseling can help assess the risk of passing CF onto offsprings.

Other information

There is no guarantee that undergoing ART will result in a successful pregnancy. In the case of IVF, the success rates vary between 20 to 40 percent and patients might often have to undergo multiple cycles of IVF before pregnancy can be achieved.

Multiple pregnancies (twins, triplets, etc.) are common for those undergoing IVF. This can be minimized by ensuring that only a minimal number of embryos are transferred to the woman’s body.

While IUI is largely a simple procedure, there is a risk of infection due to the insertion of the catheter. The success rates of IUI are lower than IVF (5 to 25 percent).

Irrespective of the type of ART, there is a two-week waiting period before the result of the procedure is confirmed, which may be an emotional challenge for couples undergoing the treatment.

