Cystic Fibrosis: Its Impact at Women’s Fertility and their Pregnancy. A Narrative Review

Authors

  • C. Loukopoulou Medical Student, University of Ioannina, Greece
  • F. Gkrozou Department of Obstetrics and Gynaecology, Medical School, University Hospital of Ioannina, Greece
  • A. Geroula Medical Student, University of Ioannina, Greece
  • N. Mantzoukidou1 Medical Student, University of Ioannina, Greece
  • A. Zoi Department of Obstetrics and Gynaecology, Medical School, University Hospital of Ioannina, Greece
  • C. Skentou Department of Obstetrics and Gynaecology, Medical School, University Hospital of Ioannina, Greece
  • A. Vatopoulou Department of Obstetrics and Gynaecology, Medical School, University Hospital of Ioannina, Greece
  • O. Tsonis Assisted Conception Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK

DOI:

https://doi.org/10.14738/bjhmr.102.14164

Keywords:

Cystic Fibrosis, fertility, pregnancy complications, reproductive medicine

Abstract

Women with cystic fibrosis (CF) leave more years than in the past. This is the reason why this population has increased expectations for a more “normal” life. We aimed to assess current maternal and fetal outcomes in women with CF with varied pre-pregnancy lung function, in addition with fertility outcome after artificial reproductive technology (ART). A review of relative literature was conducted, using the MEDLINE database, the ScienceDirect database and Google scholar and relevant keywords. Studies confirmed that more women with CF are considering pregnancy. Unplanned pregnancies also are happening, and women need the right guidance. Most women will have normal pregnancies, but preterm births are common. Optimization of treatment is recommended during family planning or pregnancy. Reduced fertility may be overcome with ART. With careful multidisciplinary antenatal and intrapartum management, successful outcomes have been obtained in women with CF.

 

 

References

Edenborough FP. Respiratory diseases in pregnancy bullet 4: Women with cystic fibrosis and their potential for reproduction. Thorax. 2001 Aug 1;56(8):649–55.

Padoan RF, Quattrucci S, Amato A, Salvatore M, Salvatore D, Campagna G. Perinatal outcomes in women with cystic fibrosis: Data from the Italian Cystic Fibrosis Registry. Acta Obstet Gynecol Scand. 2021 Aug 14;100(8):1439–44.

Lyon A, Bilton D. Fertility issues in cystic fibrosis. Paediatr Respir Rev. 2002 Sep;3(3):236–40.

Kazmerski TM, Gmelin T, Slocum B, Borrero S, Miller E. Attitudes and Decision Making Related to Pregnancy Among Young Women with Cystic Fibrosis. Matern Child Health J. 2017 Apr 16;21(4):818–24.

Burden C, Ion R, Chung Y, Henry A, Downey DG, Trinder J. Current pregnancy outcomes in women with cystic fibrosis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2012 Oct;164(2):142–5.

Tournier A, Murris M, Prevotat A, Fanton A, Bettiol C, Parinaud J. Fertility of women with cystic fibrosis: a French survey. Reprod Biomed Online. 2019 Sep;39(3):492–5.

Traxler SA, Chavez V, Hadjiliadis D, Shea JA, Mollen C, Schreiber CA. Fertility considerations and attitudes about family planning among women with cystic fibrosis. Contraception. 2019 Sep;100(3):228–33.

Edenborough FP, Borgo G, Knoop C, Lannefors L, Mackenzie WE, Madge S, et al. Guidelines for the management of pregnancy in women with cystic fibrosis. Journal of Cystic Fibrosis. 2008 Jan;7:S2–32.

Gage LA. What Deficits in Sexual and Reproductive Health Knowledge Exist among Women with Cystic Fibrosis? A Systematic Review. Health Soc Work. 2012 Feb 1;37(1):29–36. 75

Leech MM, Stransky OM, Talabi MB, Borrero S, Roe AH, Kazmerski TM. Exploring the reproductive decision support needs and preferences of women with cystic fibrosis,. Contraception. 2021 Jan;103(1):32–7.

Frayman KB, Sawyer SM. Sexual and reproductive health in cystic fibrosis: a life-course perspective. Lancet Respir Med. 2015 Jan;3(1):70–86.

Frayman KB, Chin M, Sawyer SM, Bell SC. Sexual and reproductive health in cystic fibrosis. Curr Opin Pulm Med. 2020 Nov;26(6):685–95.

Ladores S, Corcoran J, Campbell C, Bray L, Brown J, Woods B, et al. 230: State of fertility preservation counseling: Knowledge, experiences, and preferences of partners of women with cystic fibrosis. Journal of Cystic Fibrosis. 2021 Nov;20:S111–2.

Kazmerski TM, Prushinskaya O v., Hill K, Nelson E, Leonard J, Mogren K, et al. Sexual and Reproductive Health of Young Women With Cystic Fibrosis: A Concept Mapping Study. Acad Pediatr. 2019 Apr;19(3):307–14.

Sriramulu D, editor. Cystic Fibrosis - Renewed Hopes Through Research. InTech; 2012.

Cohen-Cymberknoh M, Gindi Reiss B, Reiter J, Lechtzin N, Melo J, Pérez G, et al. Baseline Cystic fibrosis disease severity has an adverse impact on pregnancy and infant outcomes, but does not impact disease progression. Journal of Cystic Fibrosis. 2021 May;20(3):388–94.

Thorpe-Beeston J, Madge S, Gyi K, Hodson M, Bilton D. The outcome of pregnancies in women with cystic fibrosis-single centre experience 1998-2011. BJOG. 2013 Feb;120(3):354–61.

Hughan KS, Daley T, Rayas MS, Kelly A, Roe A. Female reproductive health in cystic fibrosis. Journal of Cystic Fibrosis. 2019 Oct;18:S95–104.

Shteinberg M, Taylor-Cousar JL, Durieu I, Cohen-Cymberknoh M. Fertility and Pregnancy in Cystic Fibrosis. Chest. 2021 Dec;160(6):2051–60.

Nash EF, Middleton PG, Taylor-Cousar JL. Outcomes of pregnancy in women with cystic fibrosis (CF) taking CFTR modulators – an international survey. Journal of Cystic Fibrosis. 2020 Jul;19(4):521–6.

Taylor-Cousar JL. CFTR Modulators: Impact on Fertility, Pregnancy, and Lactation in Women with Cystic Fibrosis. J Clin Med. 2020 Aug 21;9(9):2706.

Foil KE, Powers A, Raraigh KS, Wallis K, Southern KW, Salinas D. The increasing challenge of genetic counseling for cystic fibrosis. Journal of Cystic Fibrosis. 2019 Mar;18(2):167–74.

Shteinberg M, Lulu A ben, Blumenfeld Z, Gur M, Bentur L, Mussaffi H, et al. 223 Infertility among women with cystic fibrosis: prevalence and risk factors. Journal of Cystic Fibrosis. 2016 Jun;15:S108.

Shteinberg M, Lulu A ben, Downey DG, Blumenfeld Z, Rousset-Jablonski C, Perceval M, et al. Failure to conceive in women with CF is associated with pancreatic insufficiency and advancing age. Journal of Cystic Fibrosis. 2019 Jul;18(4):525–9.

VanWort TA, Lee JA, Karvir H, Whitehouse MC, Beim PY, Copperman AB. Female cystic fibrosis mutation carriers and assisted reproductive technology: does carrier status affect reproductive outcomes? Fertil Steril. 2014 Nov;102(5):1324–30.

Johannesson M, Landgren BM, Csemiczky G, Hjelte L, Gottlieb C. Female patients with cystic fibrosis suffer from reproductive endocrinological disorders despite good clinical status. Human Reproduction. 1998

Danziger KL. Improved detection of cystic fibrosis mutations in infertility patients with DNA sequence analysis. Human Reproduction. 2004 Jan 29;19(3):540–6.

O’Connor KE, Goodwin DL, NeSmith A, Garcia B, Mingora C, Ladores SL, et al. Elexacafator/tezacaftor/ivacaftor resolves subfertility in females with CF: A two center case series. Journal of Cystic Fibrosis. 2021 May;20(3):399–401. FIGURE LEGEND Management of fertility problems Assisted Reproductive CFTR modulators Technology (ART) success rate: 80-85% Intrauterine insemination In vitro fertilization Direct thinning effect on (IUI) (IVF) cervical mucus viscosity. Achievement of a more suitable cervical pH. Change of hormonal responses. Improved nutrition of Minimally invasive. patient. Incapabillity of More invasive. Better regulation of Capabillity of menstrual cycles Adjustment preimplantation genetic preimplantation of the hypothalamic-pituitarytesting (PGT). adrenal axis. Increased risk of genetic genetic testing Decrease the effectiveness of malformations (PGT). oral contraceptives due to the reduction of circulating estrogens. Disadvantages of Assisted Reproductive Technology (ART) Multiple pregnancy Ovarian hyperstimulation syndrome Neonatal adverse outcomes Expensive

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Published

2023-03-22

How to Cite

C. Loukopoulou, F. Gkrozou, A. Geroula, N. Mantzoukidou1, A. Zoi, C. Skentou, … O. Tsonis. (2023). Cystic Fibrosis: Its Impact at Women’s Fertility and their Pregnancy. A Narrative Review. British Journal of Healthcare and Medical Research, 10(2), 65–79. https://doi.org/10.14738/bjhmr.102.14164