In the first, long-running study that systematically assessed the use of ART in infertile women with cystic fibrosis (CF), researchers have concluded that such techniques are safe and effective in helping patients conceive without any morbidity and mortality, either in the mother or offspring. The results of the study were presented at the 25th annual conference of the European Society of Human Reproduction and Embryology held at Amsterdam, from June 28 to July 1, 2009.
Sylvie Epelboin and colleagues from the Hôpital Cochin Saint Vincent de Paul, Paris evaluated 24 infertile patients with CF from 1998 to 2008. Fertility treatment was given to 15 subjects (median age=29.6 years) who presented with various negative post-coital tests, with other fertility factors being normal. The male partners of the participants had no CF gene mutation and the couples underwent genetic counseling. The couples were subjected to 38 attempts of intrauterine insemination (IUI), which resulted in 15 successful pregnancies and 2 failures. Of the 2 failures, IVF led to conception in one woman, while the other patient who had ovarian failure, reported positive result after oocyte donation.
Overall, 12 live births, 2 ongoing pregnancies, and 3 miscarriages were reported. At an average of about 37 gestational weeks, all patients had a normal vaginal delivery, except for one who underwent cesarean section. It was noted that 50% of the women had gestational diabetes, with a slight reduction in pulmonary function during the year of their pregnancy. The birth weights of the babies varied from 1,910 g to 3,500 g, with 18.2% below 2,500 g (low birth weight). The researchers reported that the mothers and 12 children born till date, aged between 1 month and 10 years, are all healthy.
Cystic fibrosis, an inherited life-threatening disease, affects around 30,000 people in the United States, with an additional 10 million being carriers of the defective CF gene. The advancements in the treatment and management of CF patients have led to an increase in the median predicted age of survival from 32 years in 2000 to 37.4 years in 2008. Women with CF are less fertile when compared to those who are healthy, and usually have thick cervical mucus that makes it difficult for them to conceive naturally. Since a large number of CF patients are reaching reproductive age, many are seeking various reproductive options to achieve parenthood.
The positive findings from the long-running study offer hope to women suffering from CF that ART has the potential to be an effective reproductive strategy, without increasing the risk for medical ailments or deaths, either for themselves or the child. It was also suggested that ART could be equally effective for infertile men afflicted with CF. Additionally, the investigators indicated that physicians should aim towards achieving singleton pregnancies in contrast to multiple pregnancies, in women with CF due to the following reasons:
• Multiple pregnancies would cause additional burden on their lungs, hearts, and nutritional balance
• One of the symptoms of CF, chronic cough, may be associated with increased risk of premature birth
• Easier post-natal management with single births
The recent research suggested that medical, genetic, and ethical counseling prior to the initiation of fertility treatment is vital in patients with CF. Since the patients are at a high risk of developing conditions such as diabetes and glucose intolerance, the scientists further emphasize on the need for frequent and long-term monitoring (pre-, during and post-pregnancy) of CF patients by a dedicated CF, ART, and obstetrics team.
References
1. Women with cystic fibrosis can have safe and successful fertility treatment. Press Release. ESHRE. Last Accessed July 14, 2009.
2. Epelboin S, Viot G, Patrat C, et al. Indication, management and outcome of assisted reproductive techniques in women with cystic fibrosis. Paper presented at: 25th Annual Conference of the European Society of Human Reproduction and Embryology;June 30, 2009;Amsterdam, Netherlands.
