Comprehensive semen examination in patients with cystic fibrosis
Introduction. Cystic fibrosis (CF) is a common genetic disorder associated with male infertility. Almost all men with CF are infertile due to obstructive azoospermia.The objective is to evaluate semen parameters, excretion of seminal fluid, and spermatogenesis in CF patients.Materials and methods. We examined 44 male CF patients with pancreatic sufficiency (n = 20) and pancreatic insufficiency (n = 24). Standard semen analysis, quantitative karyological analysis of  immature germ cells from ejaculate sediment, biochemical semen  analysis (fructose, α-glucosidase, citric acid) were performed.Results. Semen analysis diagnosed azoospermia in 77.3 % patients, severe oligozoospermia (< 1 million/ml) and other diagnoses (oligozoospermia, asthenozoospermia, normozoospermia) in 13.6 %  and 9.1 % patients, respectively. The signs of obstruction of the vas  deferens and aplasia of seminal vesicles were observed in 91 %  patients. Azoospermia, oligospermia, pH <7.0 and low content of  fructose in the semen samples result from bilateral obstruction of the vas deferens and aplasia of the seminal vesicles.Conclusion. Cryptozoospermia and immature germ cells, detected in ejaculate sediment in all azoospermic patients with CF, indicated aplasia, but not congenital absence of the vas deferens. The majority of CF patients presented signs of seminal ducts obstruction and  impaired spermatogenesis and seminal fluid secretion. In contrast to pancreatic-sufficient CF male patients, pancreatic-insufficient CF  patients can be fertile and have no obstruction of seminal ducts and severe pathozoospermia.