Cystic fibrosis (cystic fibrosis, cystic fibrosis, CF) is a genetic disease that affects a number of systems in the body, from the digestive tract to the lungs. In males, cystic fibrosis causes atrophy of the vas deferens early in embryonic development. Cystic fibrosis leads to long-term respiratory problems, but one of its lesser-known complications is affecting fertility. While most women with cystic fibrosis do not have difficulty conceiving, cystic fibrosis causes infertility in men. The majority of men with cystic fibrosis experience problems affecting their reproductive health. This is due to a structural defect called bilateral congenital absence of the vas deferens (CBAVD), which occurs in 98% of men with cystic fibrosis. Normally, sperm develop in the testicles and travel to the epididymis, a duct attached to the testicle. Its function is to allow chemical changes to take place that promote sperm motility and storage until ejaculation occurs. Sperm move from the epididymis through the vas deferens, a pair of tubular organs that carry sperm from the epididymis to the urethra. In men with bilateral congenital absence of the vas deferens (CBAVD), however, the vas deferens is completely blocked or completely absent. This means that the sperm are trapped in the testicle or epididymis, which is why they fail to reach the ejaculate (obstructive azoospermia). Not all men experience the severe manifestations of cystic fibrosis. In fact, in many cases, men have none of the respiratory or digestive symptoms of cystic fibrosis. Often the only symptom they have is the absence of a vas deferens. Although the majority of men with cystic fibrosis experience reproductive problems, they do not suffer from infertility. Up to 90% of men with cystic fibrosis produce functional semen. Assisted reproductive technologies (ART) can help in many of these cases. It is possible to undergo surgical extraction of sperm, which is subsequently used for in vitro fertilization. The surgical extraction of semen is called microsurgical epididymal sperm aspiration (MESA). After the surgeon retrieves the sperm, they are processed and selected for implantation directly into the egg. Because cystic fibrosis is a genetic disease, it is crucial that the partner is also tested for the gene and offered appropriate medical genetic counseling. Hypogonadism is another condition that is associated with cystic fibrosis in men. Hypogonadism refers to a clinical syndrome that occurs in men with low testosterone levels. In cystic fibrosis, hypogonadism tends to be multifactorial. Chronic inflammation, recurrent infections, and regular use of glucocorticoids are just some of the factors in men with cystic fibrosis that can lead to hypogonadism.The exact prevalence of hypogonadism in men with cystic fibrosis remains unknown. However, in a study involving 40 men with cystic fibrosis, decreased serum testosterone levels were noted. Hypogonadism can also lead to decreased bone mineral density, decreased muscle mass, loss of energy, infertility, and depressed mood. Research on hypogonadism in men with cystic fibrosis is limited, so the impact of the disorder on the severity of cystic fibrosis is not fully understood. Men with cystic fibrosis should be screened for hypogonadism, and the underlying cause of the condition should also be established. Treatment includes testosterone replacement therapy in the form of injections, pellets, patches or gels. References: 1. Sawyer SM, Farrant B, Wilson J, Ryan G, O’Carroll M, Bye P, et al. Sexual and reproductive health in men with cystic fibrosis: consistent preferences, inconsistent practices 2. Ahmad A., Ahmed A., Patrizio P. Cystic fibrosis and fertility 3. Stuhrmann M., D?rk T. CFTR gene mutations and male infertility 4. Kaplan E., Shwachman H., Perlmutter AD, Rule A., Khaw KT, Holsclaw DS Reproductive failure in males with cystic fibrosis. N Engl J Med. 5. Yoon JC, Casella JL, Litvin M., Dobs AS Male reproductive health in cystic fibrosis