AMSTERDAM — Demand for fertility treatment is increasing among women with cystic fibrosis, and treatment has resulted in excellent maternal and neonatal outcomes, according to Dr. Sylvie Epelboin of the Hôpital Saint Vincent de Paul in Paris.
“Previously these women were not expected to live beyond 20 years, but now 45% of them are reaching adulthood, and their average life expectancy exceeds 38 years,” she said in an interview.
Yet worldwide, only 1,083 births to women with the condition have been reported in the literature.
Natural conception in women with cystic fibrosis (CF) is usually not possible because they produce exceedingly thick cervical mucus, Dr. Epelboin explained at the annual meeting of the European Society of Human Reproduction and Embryology.
However, they can be treated with either intrauterine insemination (IUI) or in-vitro fertilization (IVF) with high success rates—as long as precautions are taken, she said.
Her study, the first long-term analysis of fertility treatment in such women (1998–2008), included 24 women with CF who were unable to conceive naturally.
After counseling, three women were discouraged from pursuing treatment because of poor health, and six others are still being assessed.
“It's a real challenge to consult these women and to talk about life, their future baby, and death,” she said. “We have had to learn how to tell patients, 'I want to help you but your child might be an early orphan.'”
A total of 15 women were initially offered IUI, followed by IVF if they did not conceive.
There was a clinical pregnancy rate of 87% and an ongoing pregnancy rate of 80% in the women whose median age was 29.6 years, she said. Seventeen pregnancies were achieved in 13 women—15 through IUI, 1 with regular IVF, and 1 with IVF/egg donation. There were three miscarriages and 13 births; one pregnancy is in the third trimester, Dr. Epelboin reported.
Although there was a 31% rate of premature birth, all deliveries occurred after 35 weeks (mean 37.6 weeks), and there were no babies with very low birth weights of less than 1,500 g (mean birth weight was 2,842 g).
Preconceptional counseling is essential for women with CF to ensure that their pulmonary function is optimal. Pancreatic insufficiency requires that they receive vitamin and nutritional supplementation and that they have an optimal body mass index; if they are diabetic, their condition must be well controlled, Dr. Epelboin advised.
Additionally, their obstetrical care is intense, involving early home rest, monthly obstetrical visits to monitor fetal growth and gestational diabetes, and regular visits with a diabetologist and CF expert. Fifty percent of the cohort had gestational diabetes, and many had a slight decline in lung function during the year of pregnancy, although all have remained healthy, she said. The oldest child from the cohort is currently 10 years old.
“The results are good news because they show that fertility treatment works and does not increase medical risks for mothers or children,” said Dr. Epelboin, who reported no conflicts.