Michal Shteinberg1, Adi Ben Lulu2, Damian G Downey3, Zeev Blumenfeld4, Christine Rousset-Jablonski5, Marie Perceval5, Alessandra Colombo6, Nili Stein7, Galit Livnat8, Michal Gur9, Lea Bentur9, Huda Mussaffi10, Hannah Blau10, Ifat Sarouk11, Adi Dagan11, Eitan Kerem12, Micha Aviram13, Elie Picard14, Stefano Aliberti6, Antonio Álvarez15, Javier Perez Miranda15, Eva Polverino15, Isabelle Durieu5, J Stuart Elborn3, Malena Cohen-Cymberknoh12. 1. Pulmonology Institute, Carmel Medical Center, Israel; Cystic Fibrosis Center, Carmel Medical Center, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel. Electronic address: michalsh@technion.ac.il. 2. Pulmonology Institute, Carmel Medical Center, Israel; Cystic Fibrosis Center, Carmel Medical Center, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel. 3. Center for Experimental Medicine, Queens University Belfast, , Belfast, UK; Northern Ireland Regional Adult Cystic Fibrosis Center, Belfast Health and Social Care Trust, Belfast, UK. 4. Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel; Women Health Center, Meuhedet, Haifa, Israel. 5. Cystic Fibrosis Center, Groupement Hospitalier Sud Hospices Civils de Lyon, Lyon, France. 6. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy. 7. Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel. 8. Cystic Fibrosis Center, Carmel Medical Center, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel. 9. Ruth and Bruce Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel; Cystic Fibrosis Center, Rambam Medical Center, Haifa, Israel. 10. Kathy and Lee Graub Cystic Fibrosis Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 11. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.; Cystic Fibrosis Center, Sheba Medical Center, Tel Aviv, Israel. 12. Cystic Fibrosis Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. 13. Cystic Fibrosis Center, Soroka Medical Center, Beersheva, Israel. 14. Cystic Fibrosis Center, Shaare Zedek Medical Center, Jerusalem, Israel. 15. Adult CF Center, Hospital Universitari Vall d'Hebron- VHIR, Barcelona, Spain.
Abstract
OBJECTIVE: The causes of subfertility in women with CF though multifactorial are not well described. Our aim in this study was to determine the prevalence and factors associated with female subfertility among women with CF. METHODS: A retrospective multinational study from 11 CF centers in 5 countries (Israel, France, Spain, Italy, UK) including women with CF was undertaken. Sub/infertility was defined as not achieving a spontaneous pregnancy after one year of unprotected sexual intercourse. Data including genetics, pancreatic insufficiency (PI), prevalence of diabetes (CFRD), lung function, nutritional status measured by body mass index (BMI), sputum bacterial colonization, and rate of pulmonary exacerbations were collected from patients' files. RESULTS: Out of 605 women, 241 attempted pregnancy. Of these, 84 (35%) had subfertility, and 67 of them eventually became pregnant. Females attempting conception were older but had better pulmonary function and nutrition compared to those who did not. In a multivariate analysis, PI (OR 1.9 [1.03-3.5], p = .04) and older age (OR 3.9 [2.1-7.3] p < .0001) were associated with subfertility. Lung function, BMI, CFRD, Presence of two class I-III mutations and number of exacerbations in the year prior to fertility attempts were not associated with subfertility. CONCLUSIONS: The prevalence of subfertility among women with CF (35%) is higher than the expected 5-15% subfertility in the general population. Older age and pancreatic insufficiency are associated with subfertility in women with CF.
OBJECTIVE: The causes of subfertility in women with CF though multifactorial are not well described. Our aim in this study was to determine the prevalence and factors associated with female subfertility among women with CF. METHODS: A retrospective multinational study from 11 CF centers in 5 countries (Israel, France, Spain, Italy, UK) including women with CF was undertaken. Sub/infertility was defined as not achieving a spontaneous pregnancy after one year of unprotected sexual intercourse. Data including genetics, pancreatic insufficiency (PI), prevalence of diabetes (CFRD), lung function, nutritional status measured by body mass index (BMI), sputum bacterial colonization, and rate of pulmonary exacerbations were collected from patients' files. RESULTS: Out of 605 women, 241 attempted pregnancy. Of these, 84 (35%) had subfertility, and 67 of them eventually became pregnant. Females attempting conception were older but had better pulmonary function and nutrition compared to those who did not. In a multivariate analysis, PI (OR 1.9 [1.03-3.5], p = .04) and older age (OR 3.9 [2.1-7.3] p < .0001) were associated with subfertility. Lung function, BMI, CFRD, Presence of two class I-III mutations and number of exacerbations in the year prior to fertility attempts were not associated with subfertility. CONCLUSIONS: The prevalence of subfertility among women with CF (35%) is higher than the expected 5-15% subfertility in the general population. Older age and pancreatic insufficiency are associated with subfertility in women with CF.
Authors: Kate E O'Connor; Dana L Goodwin; Andrew NeSmith; Bryan Garcia; Christina Mingora; Sigrid L Ladores; Steve M Rowe; Stefanie Krick; George M Solomon Journal: J Cyst Fibros Date: 2021-01-19 Impact factor: 5.527