1
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Hubbard L, Rambhatla A, Colpi GM. Differentiation between nonobstructive azoospermia and obstructive azoospermia: then and now. Asian J Androl 2024:00129336-990000000-00247. [PMID: 39268812 DOI: 10.4103/aja202475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/02/2024] [Indexed: 09/15/2024] Open
Abstract
Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%-15% of infertile men. Confirmation of azoospermia subsequently necessitates an early causal differentiation between obstructive azoospermia (OA) and nonobstructive azoospermia (NOA). Although less common when compared to NOA, OA can represent upward 20%-40% of cases of azoospermia. While there are a multitude of etiologies responsible for causing NOA and OA, correctly distinguishing between the two types of azoospermia has profound implications in managing the infertile male. This review represents an amalgamation of the current guidelines and literature which will supply the reproductive physician with a diagnostic armamentarium to properly distinguish between NOA and OA, therefore providing the best possible care to the infertile couple.
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Affiliation(s)
- Logan Hubbard
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202-3450, USA
| | - Amarnath Rambhatla
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202-3450, USA
| | - Giovanni M Colpi
- Andrology and IVF Center, Next Fertility Procrea, Lugano 6900, Switzerland
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2
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Böhm L, Schirm N, Zimmermann T, Meyer N, von Versen-Höynck F. Examining the impact of solid organ transplantation on family planning: pre- and post-transplantation pregnancy evaluations for both women and men. Arch Gynecol Obstet 2024:10.1007/s00404-024-07689-7. [PMID: 39152283 DOI: 10.1007/s00404-024-07689-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE The aim of this study was to collect and analyze information from pregnancies of organ transplanted women and partners of organ transplanted men. The goal was to enhance counseling regarding pregnancy planning and management and to enable more targeted monitoring to improve maternal and child health. METHODS In this retrospective, multicenter cohort study, women and men aged 18 to 45 who had undergone organ transplantation in Germany, Austria, and Switzerland were surveyed about their pregnancies before and after transplantation by using a self-developed questionnaire. RESULTS Even through transplanted women planned their pregnancies more carefully than before transplantation, they still experienced more pregnancy complications afterward. The live birth rate for pregnancies of partners of transplanted men, especially men who received a thoracic organ, was lower compared to before transplantation. Furthermore, this study showed that pregnancies of the partners of male transplant recipients occurred significantly less by spontaneous conception in comparison to pregnancies of transplanted women. CONCLUSION Pregnancies after organ transplantation are possible but associated with an increased risk of pregnancy complications. Therefore, early counseling for transplanted women and men who wish to have children, along with extensive monitoring during pregnancy, is necessary.
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Affiliation(s)
- Lea Böhm
- Department of Gynecology and Obstetrics, AG Reproductive Medicine and Molecular Perinatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Nina Schirm
- Department of Gynecology and Obstetrics, AG Reproductive Medicine and Molecular Perinatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Tanja Zimmermann
- Department of Psychosomatics and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Nadia Meyer
- Department of Gynecology and Obstetrics, AG Reproductive Medicine and Molecular Perinatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frauke von Versen-Höynck
- Department of Gynecology and Obstetrics, AG Reproductive Medicine and Molecular Perinatology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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3
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Kaluzna-Mlynarczyk A, Pucher B, Sroczynski J, Kotowski M, Jonczyk-Potoczna K, Szydlowski J. The development of paranasal sinuses in patients with cystic fibrosis: sinuses volume analysis. Eur Arch Otorhinolaryngol 2024; 281:795-803. [PMID: 37882847 PMCID: PMC10796702 DOI: 10.1007/s00405-023-08236-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a severe systemic disease that affects many aspects of patients' lives. It is known that the progression of the disease adversely affects lower and upper airways including the paranasal sinuses. However, its impact on sinus development in the pediatric population is not fully examined. The purpose of this study was to evaluate the development of the paranasal sinuses in a pediatric population with CF and compare it to a control group consisting of healthy children. METHODS The results of computed tomography (CT) scans of children with the disease and the control group were evaluated. The study included 114 CT images of children in the study group and 126 images of healthy children aged 0-18 years. The volumes of maxillary, frontal, and sphenoid sinuses were analyzed. The obtained results were compared with those of the control group and analyzed statistically. RESULTS The volume and the development of the paranasal sinuses in both groups increased with age, but statistically significant differences were found between the study and the control group. CONCLUSIONS The obtained results provide valuable knowledge regarding the impact of the CF on sinuses development. Also, they may be important in understanding the progression of the disease and its influence on the quality and length of life of patients. The results may contribute to enhanced diagnostics and have implications for improving therapy for patients with chronic sinusitis associated with CF.
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Affiliation(s)
- Agata Kaluzna-Mlynarczyk
- Department of Pediatric Otolaryngology, Institute of Pediatrics, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572, Poznań, Poland.
- Doctoral School, Poznan University of Medical Sciences, Bukowska 70, 60-812, Poznań, Poland.
| | - Beata Pucher
- Department of Pediatric Otolaryngology, Institute of Pediatrics, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572, Poznań, Poland
| | - Jakub Sroczynski
- Department of Pediatric Otolaryngology, Institute of Pediatrics, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572, Poznań, Poland
| | - Michal Kotowski
- Department of Pediatric Otolaryngology, Institute of Pediatrics, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572, Poznań, Poland
| | - Katarzyna Jonczyk-Potoczna
- Department of Pediatric Radiology, Institute of Pediatrics, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572, Poznań, Poland
| | - Jarosław Szydlowski
- Department of Pediatric Otolaryngology, Institute of Pediatrics, Poznan University of Medical Sciences, Szpitalna 27/33, 60-572, Poznań, Poland
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4
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Meiss LN, Jain R, Kazmerski TM. Family Planning and Reproductive Health in Cystic Fibrosis. Clin Chest Med 2022; 43:811-820. [PMID: 36344082 DOI: 10.1016/j.ccm.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Family planning in cystic fibrosis (CF) is an increasingly important aspect of care, as improvements in care and outcomes lead to a rise in the number of pregnancies and parenthood in people with CF. This article highlights: (1) Health considerations for people with CF related to pregnancy, contraception, and parenthood. (2) Facets of reproductive planning, fertility, and preconception counseling. (3) Relationship-centered reproductive health discussions.
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Affiliation(s)
- Lauren N Meiss
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Raksha Jain
- Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8558, USA
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, PA, USA.
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5
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Pregnancies and Gynecological Follow-Up after Solid Organ Transplantation: Experience of a Decade. J Clin Med 2022; 11:jcm11164792. [PMID: 36013030 PMCID: PMC9409658 DOI: 10.3390/jcm11164792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
In recent years, solid organ transplantations, such as kidney or lung grafts, have been performed worldwide with an improvement of quality of life under immunosuppressive therapy and an increase in life expectancy, allowing young women to consider childbearing. In the current study, we conduct a retrospective study in two French centers for kidney and lung transplantations to evaluate the rate and outcomes of pregnancies, contraception and gynecological monitoring for women under 40 years old who underwent solid organ transplantation. Among 210 women, progestin was the most widely used contraceptive method. Of the 210 women, 24 (11.4%) conceived 33 pregnancies of which 25 (75.8%) were planned with an immunosuppressant therapy switch. Of the 33 pregnancies, 7 miscarried (21.2%) and 21 (63.7%) resulted in a live birth with a high rate of pre-eclampsia (50%). No graft rejections were observed during pregnancies. Among the deliveries, 19 were premature (90.5%, mostly due to induced delivery) and the C-section rate was high (52.4%). No particular pathology was identified among newborns. We conclude that pregnancies following solid organ transplantation are feasible, and while they are at an increased risk of pre-eclampsia and prematurity, they should still be permitted with close surveillance by a multidisciplinary care team.
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6
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Singh J, Towns S, Jayasuriya G, Hunt S, Simonds S, Boyton C, Middleton A, Kench A, Pandit C, Keatley LR, Chien J, Bishop J, Song Y, Robinson P, Selvadurai H, Middleton PG, Fitzgerald DA. Transition to adult care in cystic fibrosis: The challenges and the structure. Paediatr Respir Rev 2022; 41:23-29. [PMID: 32917516 DOI: 10.1016/j.prrv.2020.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
In developed countries, it is projected that there will be a 70% increase in the number of adults living with Cystic Fibrosis (CF) between 2010 and 2025. This shift in demographics highlights the importance of high-quality transition programmes with developmentally appropriate integrated health care services as the individual moves through adolescence to adulthood. Adolescents living with CF face additional and unique challenges that may have long-term impacts on their health, quality of life and life-expectancy. CF specific issues around socially challenging symptoms, body image, reproductive health and treatment burden differentiate people with CF from their peers and require clinicians to identify and address these issues during the transition process. This review provides an overview of the health, developmental and psychosocial challenges faced by individuals with CF, their guardians and health care teams considering the fundamental components and tools that are required to build a transition programme that can be tailored to suit individual CF clinics.
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Affiliation(s)
- Jagdev Singh
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Susan Towns
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Adolescent Medicine, Sydney Children's Hospital Network, Australia
| | - Geshani Jayasuriya
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, Sydney, NSW, Australia; Department of Adolescent Medicine, Sydney Children's Hospital Network, Australia
| | - Sharon Hunt
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sharon Simonds
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Christie Boyton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anna Middleton
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea Kench
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Chetan Pandit
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Lucy R Keatley
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Jimmy Chien
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, NSW, Australia
| | - Jennifer Bishop
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Yang Song
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia; Westmead Clinical School, University of Sydney, NSW, Australia
| | - Paul Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Peter G Middleton
- Department of Adolescent Medicine, Sydney Children's Hospital Network, Australia; Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Naz Khan F, Mason K, Roe AH, Tangpricha V. CF and male health: Sexual and reproductive health, hypogonadism, and fertility. J Clin Transl Endocrinol 2022; 27:100288. [PMID: 34987977 PMCID: PMC8695349 DOI: 10.1016/j.jcte.2021.100288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022] Open
Abstract
Over 30,000 people in the United States are diagnosed with cystic fibrosis (CF), and over 50% of those with CF are male. Men with CF face specific and sometimes difficult sexual and reproductive health (SRH) issues, including infertility and hypogonadism. Male infertility affects over 95% of men with CF, with obstructive azoospermia resulting from congenital bilateral absence of the vas deferens being the primary cause of infertility. SRH education for males with CF represents an important opportunity for clinical improvement, as the majority of men with CF know that their disease impacts their fertility, however the depth of this understanding varies significantly. Hypogonadism is a clinical syndrome that affects men with low testosterone level, a common finding among men with CF that has clinical implications and can significantly affect quality of life. Better understanding of SRH attitudes, the prevalence of hypogonadism, and management of infertility in men with CF should remain future research priorities.
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Affiliation(s)
- Farah Naz Khan
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, United States
| | - Kelly Mason
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Virginia, Charlottesville, VA, United States
| | - Andrea H Roe
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta GA and the Atlanta VA Medical Center, Atlanta, GA, United States
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8
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Identification and selection of healthy spermatozoa in heterozygous carriers of the Phe508del-variant of the CFTR-gene in assisted reproduction. Sci Rep 2022; 12:1866. [PMID: 35115637 PMCID: PMC8814069 DOI: 10.1038/s41598-022-05925-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
The pathogenic variant Phe508del of the CFTR-gene is the most frequent cause of cystic fibrosis (CF). Whereas male CF-patients are infertile due to bilateral agenesis of the efferent ducts, the fertility status of male heterozygous carriers is uncertain. We aimed at demonstrating the involvement of the CFTR-ion channel during sperm capacitation and to potentially select variant-free spermatozoa in heterozygous carriers of the CFTR-variant using flow cytometry (FC). Using FC and sorting, single cell polymerase chain reaction, immuno-fluorescent staining an experimental study was performed on nine fertile semen donors and three heterozygous infertile men carrying the Phe508del gene variant. Chemical inhibition of CFTR interfered with sperm capacitation. Most viable spermatozoa of heterozygous carriers of the Phe508del variant of the CFTR-gene show immune-fluorescent CFTR. Sperm capacitation in Phe508del carriers was similar to that in healthy semen donors. Distribution of the Phe508del allele in trio data of CF-affected families corresponded to the expected recessive inheritance pattern. Infertility in Phe508del heterozygous men is unlikely to be caused by the pathogenic variant although some contribution cannot be excluded. Normal sperm capacitation in carriers of pathogenic variants of the Phe508del-gene may in part explain the high prevalence of a potentially lethal recessive disorder.
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9
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Abstract
Cystic fibrosis (CF) is one of the most commonly diagnosed genetic disorders. Clinical characteristics include progressive obstructive lung disease, sinusitis, exocrine pancreatic insufficiency leading to malabsorption and malnutrition, liver and pancreatic dysfunction, and male infertility. Although CF is a life-shortening disease, survival has continued to improve to a median age of 46.2 years due to earlier diagnosis through routine newborn screening, promulgation of evidence-based guidelines to optimize nutritional and pulmonary health, and the development of CF-specific interdisciplinary care centers. Future improvements in health and quality of life for individuals with CF are likely with the recent development of mutation-specific modulator therapies. In this review, we will cover the current understanding of the disease manifestations, diagnosis, and management as well as common complications seen in individuals with CF.
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Affiliation(s)
- Kimberly M. Dickinson
- Johns Hopkins University, School of Medicine, Eudowood Division of Pediatric Respiratory Sciences, Baltimore, MD
| | - Joseph M. Collaco
- Johns Hopkins University, School of Medicine, Eudowood Division of Pediatric Respiratory Sciences, Baltimore, MD
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10
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Yoon JC, Casella JL, Litvin M, Dobs AS. Male reproductive health in cystic fibrosis. J Cyst Fibros 2020; 18 Suppl 2:S105-S110. [PMID: 31679721 DOI: 10.1016/j.jcf.2019.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/11/2019] [Accepted: 08/11/2019] [Indexed: 10/25/2022]
Abstract
The impact of cystic fibrosis (CF) on male reproductive health is profound. The vast majority of men with CF are infertile due to obstructive azoospermia. Multiple factors associated with CF contribute to an increased prevalence of testosterone deficiency, which adversely affects muscle mass, bone density, and quality of life. This article reviews the pathophysiology, diagnosis, and management of infertility and testosterone deficiency that occur in men with CF. With improving survival of CF patients, these topics are becoming more significant in their clinical care.
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Affiliation(s)
- John C Yoon
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
| | - Julio Leey Casella
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Florida School of Medicine, Gainesville, FL, USA
| | - Marina Litvin
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Adrian S Dobs
- Division of Endocrinology and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, USA
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11
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[Cystic fibrosis and pregnancy: Outcome, prognostic factors and obstetrical management]. ACTA ACUST UNITED AC 2020; 48:428-435. [PMID: 32145451 DOI: 10.1016/j.gofs.2020.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Indexed: 11/21/2022]
Abstract
As a result of improvements in life expectancy and therapies, increasing numbers of patients with cystic fibrosis become pregnant. The first studies were pessimistic and report adverse outcomes on the fetus and the mother. In the recent publications, long-term outcome for women with cystic fibrosis does not appear to be negatively impacted by pregnancy. Furthermore, the number of women successfully completing pregnancy continues to rise. The aim of this review is to assess the outcome of pregnancy in women with cystic fibrosis and the impact of pregnancy on the disease. It is hoped it will improve the counseling for pregnant women with cystic fibrosis and their obstetrical management.
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12
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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; 39:492-495. [PMID: 31256948 DOI: 10.1016/j.rbmo.2019.04.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/04/2019] [Accepted: 04/29/2019] [Indexed: 11/17/2022]
Abstract
RESEARCH QUESTION Although the impact of cystic fibrosis on male fertility is well known, very few studies have investigated its effect on female fertility. This study aimed to evaluate the fertility status of women with cystic fibrosis. DESIGN A questionnaire was sent to 220 women with cystic fibrosis. The questions concerned their desire to become a parent, achievement or not of a pregnancy, the time to become pregnant, the means of achieving pregnancy (spontaneously or with medical assistance) and the outcome of the pregnancy. Ninety-eight patients responded to the questionnaire. RESULTS Of the 46 women who sought pregnancy, 25 (54%) had at least one live birth without treatment, while 11 (24%) required infertility treatment to obtain a live birth and 10 (22%) had no delivery. The mean time-to-pregnancy was 12 months (1-180). The reasons for preferring not to become pregnant were mainly fear of the interaction between cystic fibrosis and pregnancy and of the transmission of cystic fibrosis to children. CONCLUSIONS Fertility seems to be slightly impaired in women with cystic fibrosis, because 37% of them failed to become pregnant without medical assistance. Because the outcome of pregnancies appears normal, patients should be informed about the possibility of becoming mothers and be made aware of the risk of unwanted pregnancies.
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Affiliation(s)
- Anna Tournier
- Department of Reproductive Medicine, Toulouse University Hospital, France
| | - Marlène Murris
- Cystic Fibrosis Resource and Competence Centre for Adults, Department of Pulmonary Medicine, Toulouse University Hospital, France
| | - Anne Prevotat
- Cystic Fibrosis Resource and Competence Centre for Adults, Department of Pulmonary Medicine, Lille University Hospital, France
| | - Annlyse Fanton
- Cystic Fibrosis Resource and Competence Centre for Adults, Department of Pulmonary Medicine, Dijon University Hospital, France
| | - Célia Bettiol
- Department of Reproductive Medicine, Toulouse University Hospital, France
| | - Jean Parinaud
- Department of Reproductive Medicine, Toulouse University Hospital, France; Groupe de Recherche en Fertilité Humaine EA 3694, Université Paul Sabatier, Toulouse, France.
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13
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Jessup M, Li A, Fulbrook P, Bell SC. The experience of men and women with cystic fibrosis who have become a parent: A qualitative study. J Clin Nurs 2017; 27:1702-1712. [PMID: 29266748 DOI: 10.1111/jocn.14229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To explore the experiences of men and women with cystic fibrosis in becoming parents. BACKGROUND As lifespan for people with cystic fibrosis increases, and reproductive technology advances, having a child of their own becomes a possibility. DESIGN This study used a phenomenological framework. METHODS Seven Australian adults with cystic fibrosis were invited to describe their experiences of becoming parents in the context of a semi-structured interview. Analysis of the data involved highlighting recurrent phrases and isolating emergent themes. RESULTS Two overarching themes characterised the participants' experience: Counting the cost, as they recalled Concentric communication and Pathways to pregnancy; and Living the dream, as they cast a retrospective view over this, their major achievement, in the light of their Reaction: a dream comes true, Coping: a question of balance, Conjecture: the future redefined and Confidence: recalibrating. CONCLUSIONS While advances in cystic fibrosis care and reproductive technology have increased the possibility of individuals with cystic fibrosis becoming parents, the passage to becoming a parent is a complex process. RELEVANCE TO CLINICAL PRACTICE These findings can inform health professionals to support the adaptive work necessary for families that include members with cystic fibrosis. A contemporary understanding of this phenomenon is necessary for facilitating clinically relevant communication.
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Affiliation(s)
- Melanie Jessup
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Brisbane, QLD, Australia.,Nursing Research & Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Anne Li
- Department of Social Work, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Brisbane, QLD, Australia.,Nursing Research & Practice Development Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Scott C Bell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
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14
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Maternal and perinatal outcomes of pregnancies in women with cystic fibrosis – A single centre case-control study. Respir Med 2016; 113:22-7. [DOI: 10.1016/j.rmed.2016.02.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/07/2016] [Accepted: 02/22/2016] [Indexed: 11/24/2022]
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15
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Lapinsky SE, Nelson-Piercy C. The Lungs in Obstetric and Gynecologic Diseases. MURRAY AND NADEL'S TEXTBOOK OF RESPIRATORY MEDICINE 2016. [PMCID: PMC7152064 DOI: 10.1016/b978-1-4557-3383-5.00096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Jones GH, Walshaw MJ. Potential impact on fertility of new systemic therapies for cystic fibrosis. Paediatr Respir Rev 2015; 16 Suppl 1:25-7. [PMID: 26410278 DOI: 10.1016/j.prrv.2015.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cystic fibrosis is primarily considered a respiratory disease with superadded pancreatic dysfunction; however the underlying genetic mutation results in the abnormal function of cells throughout the body - including tissues involved in reproduction. Practically all males and up to 50% of females with CF will suffer fertility issues - the causes of which are multifactorial and could be improved by treatments that target the underlying physiological deficit, such as ivacaftor. We consider the mechanisms by which the rapidly developing field of systemic treatments for CF could impact on the fertility of this group and review the available real world evidence.
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Affiliation(s)
- Gareth Huw Jones
- Adult Cystic Fibrosis Unit, Liverpool Heart & Chest Hospital and The University of Liverpool, Liverpool, UK
| | - Martin John Walshaw
- Adult Cystic Fibrosis Unit, Liverpool Heart & Chest Hospital and The University of Liverpool, Liverpool, UK.
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17
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Abstract
Respiratory failure affects up to 0.2% of pregnancies, more commonly in the postpartum period. Altered maternal respiratory physiology affects the assessment and management of these patients. Respiratory failure may result from pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism or peripartum cardiomyopathy. Pregnancy may increase the risk or severity of other conditions, including thromboembolism, asthma, viral pneumonitis, and gastric acid aspiration. Management during pregnancy is similar to the nonpregnant patient. Endotracheal intubation in pregnancy carries an increased risk, due to airway edema and rapid oxygen desaturation following apnea. Few data are available to direct prolonged mechanical ventilation in pregnancy. Chest wall compliance is reduced, perhaps permitting slightly higher airway pressures. Optimizing oxygenation is important, but data on the use of permissive hypercapnia are limited. Delivery of the fetus does not always improve maternal respiratory function, but should be considered if benefit to the fetus is anticipated.
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Affiliation(s)
- Stephen E Lapinsky
- Mount Sinai Hospital and the Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
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Sexual and reproductive health in cystic fibrosis: a life-course perspective. THE LANCET RESPIRATORY MEDICINE 2015; 3:70-86. [DOI: 10.1016/s2213-2600(14)70231-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Patel EM, Swamy GK, Heine RP, Kuller JA, James AH, Grotegut CA. Medical and obstetric complications among pregnant women with cystic fibrosis. Am J Obstet Gynecol 2015; 212:98.e1-9. [PMID: 25025942 DOI: 10.1016/j.ajog.2014.07.018] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/08/2014] [Accepted: 07/08/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to estimate the nationwide prevalence of cystic fibrosis (CF) in pregnancy and determine what medical complications exist at delivery among pregnant women with CF. STUDY DESIGN The Nationwide Inpatient Sample (NIS) was queried for all delivery-related discharges. Women with CF were identified by International Classification of Diseases, 9th revision, Clinical Modifications codes and compared with women without CF. The prevalence of selected severe medical complications was compared between the 2 groups (NIS years 2008-2010) using multivariable logistic regression and the linear change in prevalence of CF at delivery determined (NIS years 2000-2010). RESULTS From 2000 to 2010, there was a significant linear increase in the prevalence of CF at delivery from 3.0 to 9.8 per 100,000 deliveries, in 2000 and 2010, respectively (R(2) = 0.92, P < .0001). From 2008-2010, there were 1119 deliveries to women with CF and 12,627,627 to women without CF. Women with CF were more likely to be white (P < .0001) and have diabetes (odds ratio [OR], 14.0; 95% confidence interval [CI], 11.8-16.7) or asthma (OR, 5.1; 95% CI, 4.3-6.1). Multivariable logistic regression demonstrated that women with CF were more likely to die (adjusted OR [aOR], 76.0; 95% CI, 31.6-183), require mechanical ventilation (aOR, 18.3; 95% CI, 10.8-31.2), or have pneumonia (aOR, 56.5; 95% CI, 43.2-74.1), acute renal failure (aOR, 17.3; 95% CI, 9.1-32.6), preterm labor (aOR, 2.2; 95% CI, 1.9-2.6), or an adverse composite CF outcome (aOR, 28.1; 95% CI, 21.8-36.3). CONCLUSION Pregnant women with CF are more likely to die, require mechanical ventilation, and have infectious complications compared with women without CF, although the absolute risks are low and these events are relatively rare.
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Geake J, Tay G, Callaway L, Bell SC. Pregnancy and cystic fibrosis: Approach to contemporary management. Obstet Med 2014; 7:147-55. [PMID: 27512443 PMCID: PMC4934991 DOI: 10.1177/1753495x14554022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Over the previous 50 years survival of patients with cystic fibrosis has progressively increased. As a result of improvements in health care, increasing numbers of patients with cystic fibrosis are now considering starting families of their own. For the health care professionals who look after these patients, the assessment of the potential risks, and the process of guiding prospective parents through pregnancy and beyond can be both challenging and rewarding. To facilitate appropriate discussions about pregnancy, health care workers must have a detailed understanding of the various important issues that will ultimately need to be considered for any patient with cystic fibrosis considering parenthood. This review will address these issues. In particular, it will outline pregnancy outcomes for mothers with cystic fibrosis, issues that need to be taken into account when planning a pregnancy and the management of pregnancy for mothers with cystic fibrosis or mothers who have undergone organ transplantation as a result of cystic fibrosis.
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Affiliation(s)
- James Geake
- Adult Cystic Fibrosis Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - George Tay
- Adult Cystic Fibrosis Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Leonie Callaway
- School of Medicine, The University of Queensland, Brisbane, Australia
- The Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Scott C Bell
- Adult Cystic Fibrosis Centre, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Children’s Medical Research Institute, Brisbane, Australia
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Schram CA, Stephenson AL, Hannam TG, Tullis E. Cystic fibrosis (cf) and ovarian reserve: A cross-sectional study examining serum anti-mullerian hormone (amh) in young women. J Cyst Fibros 2014; 14:398-402. [PMID: 25280785 DOI: 10.1016/j.jcf.2014.09.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 09/14/2014] [Accepted: 09/14/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Reduced female fertility in CF is believed to be due to thick cervical mucous, poor nutritional status, functional hypogonadotropic hypogonadism and possibly increased inflammation. Literature suggests that reduced ovarian reserve may also play a role. METHODS 20 women with CF and 20 controls age 18-35 years were recruited. Serum anti-mullerian hormone (AMH), estradiol and follicle stimulating hormone (FSH) were assessed as well as antral follicle count (AFC) using transvaginal ultrasound. RESULTS Women with CF had significantly lower AMH levels than controls (17.8+/-4.7 vs. 33.2+/-21.0 pmol/L respectively; p=0.004). There were no differences in estradiol, FSH or AFC. CONCLUSIONS Women with CF have reduced ovarian reserve which may contribute to sub-fertility. CF care providers should consider referring women with CF to fertility specialists early to optimize chances of pregnancy.
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Affiliation(s)
- C A Schram
- Women's College Hospital, Department of Family and Community Medicine, 76 Grenville St, Toronto, Ontario M5S 1B1, Canada.
| | - A L Stephenson
- St. Michael's Hospital, Department of Respirology, Adult Cystic Fibrosis Clinic, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - T G Hannam
- Hannam Fertility Centre, 160 Bloor St. E, Toronto, ON, M4W 1B9, Canada
| | - E Tullis
- St. Michael's Hospital, Department of Respirology, Adult Cystic Fibrosis Clinic, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
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Deighan M, Ash S, McMorrow R. Anaesthesia for parturients with severe cystic fibrosis: a case series. Int J Obstet Anesth 2013; 23:75-9. [PMID: 24361190 DOI: 10.1016/j.ijoa.2013.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 10/15/2013] [Accepted: 10/23/2013] [Indexed: 11/15/2022]
Abstract
Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. Improvements in medical management and survival of cystic fibrosis patients means more are committing to pregnancies. Although guidance for anaesthesia in this patient group is available, management and outcome data associated with more severe cases are sparse. Patients with severe cystic fibrosis require multidisciplinary input and should be managed in a tertiary referral centre. Close monitoring of respiratory function and preoperative optimisation during pregnancy are mandatory. The risk of preterm labour and delivery is increased. Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.
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Affiliation(s)
- M Deighan
- Department of Anaesthetics, National Maternity Hospital, Dublin, Ireland.
| | - S Ash
- Department of Anaesthetics, National Maternity Hospital, Dublin, Ireland
| | - R McMorrow
- Department of Anaesthetics, National Maternity Hospital, Dublin, Ireland
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24
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Michel SH, Mueller DH. Nutrition for pregnant women who have cystic fibrosis. J Acad Nutr Diet 2013; 112:1943-8. [PMID: 23174681 DOI: 10.1016/j.jand.2012.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 08/08/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Suzanne H Michel
- Clinical Nutrition/Cystic Fibrosis Center, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA.
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Giacobbe LE, Nguyen RHN, Aguilera MN, Mikhaelian M, Jacobs K, Ramin KD, Yamamura Y. Effect of Maternal Cystic Fibrosis Genotype on Diabetes in Pregnancy. Obstet Gynecol 2012. [DOI: http:/10.1097/aog.0b013e31826d7eca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Thorpe-Beeston JG, Madge S, Gyi K, Hodson M, Bilton D. The outcome of pregnancies in women with cystic fibrosis-single centre experience 1998-2011. BJOG 2012; 120:354-61. [DOI: 10.1111/1471-0528.12040] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2012] [Indexed: 11/29/2022]
Affiliation(s)
- JG Thorpe-Beeston
- Department Obstetrics and Gynaecology; Chelsea and Westminster NHS Foundation Trust; London; UK
| | - S Madge
- Department of Respiratory Medicine; Royal Brompton Hospital; London; UK
| | - K Gyi
- Department of Respiratory Medicine; Royal Brompton Hospital; London; UK
| | - M Hodson
- Department of Respiratory Medicine; Royal Brompton Hospital; London; UK
| | - D Bilton
- Department of Respiratory Medicine; Royal Brompton Hospital; London; UK
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28
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Burden C, Ion R, Chung Y, Henry A, Downey DG, Trinder J. Current pregnancy outcomes in women with cystic fibrosis. Eur J Obstet Gynecol Reprod Biol 2012; 164:142-5. [DOI: 10.1016/j.ejogrb.2012.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/23/2012] [Accepted: 06/11/2012] [Indexed: 11/15/2022]
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Nast D, Paniagua C, Anderson P. Cystic fibrosis: A clinician's tool for management of care advancing into the adult population. ACTA ACUST UNITED AC 2012; 24:625-32. [DOI: 10.1111/j.1745-7599.2012.00763.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Tierney S. Body image and cystic fibrosis: a critical review. Body Image 2012; 9:12-9. [PMID: 21963674 DOI: 10.1016/j.bodyim.2011.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 08/31/2011] [Accepted: 09/01/2011] [Indexed: 11/29/2022]
Abstract
A slight frame and poor appetite are common among patients with cystic fibrosis (CF) yet healthy body weight has been related to a better prognosis. A review of studies exploring body image (BI) among adults and adolescents with CF was conducted. Seven electronic databases were searched for potential papers. They located 128 references, of which 24 were read in full and 12 included in the review. Accepted papers suggested females with CF had a better BI compared to males, but this could compromise survival, given their preference for a low body weight. Males may be more motivated to adhere to nutritional advice because they favor a larger form. Practitioners should broach the topic of BI at clinic appointments to ensure this does not have a detrimental impact on self-management, although more research is required to guide professionals in this task.
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Affiliation(s)
- Stephanie Tierney
- School of Nursing, Midwifery and Social Work, University Place, University of Manchester, Manchester, UK.
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32
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An overview of international literature from cystic fibrosis registries. Part 3. Disease incidence, genotype/phenotype correlation, microbiology, pregnancy, clinical complications, lung transplantation, and miscellanea. J Cyst Fibros 2011; 10:71-85. [PMID: 21257352 DOI: 10.1016/j.jcf.2010.12.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 12/11/2010] [Accepted: 12/14/2010] [Indexed: 12/19/2022]
Abstract
This is the third article related to a review of the literature based on data from national cystic fibrosis (CF) patient registries up to June 2008 and covering a total of 115 published studies. It focuses on several topics: CF incidence, genotype/phenotype correlation, microbiology, pregnancy/paternity, clinical complications, lung transplantation, and others. Seventy seven papers meeting the inclusion criteria were found to be related to the topics listed above. Another seven studies, already evaluated in previous papers of this series, were recalled for specific topics. Incidence is described by several studies, results being quite different from one country to another and quite inhomogeneous among regions within the same country. Studies on genetics address the genotype/phenotype correlation and look for a predictive value of CFTR mutations in terms of clinical outcome, with controversial results. Papers on microbiology describe the clinical relevance of different pathogens and their role in the progress of CF lung disease. A few articles give information on the features of CF women undergoing a pregnancy and try to identify the ones associated with a better outcome. Studies on clinical complications discuss prevalence and the role of haemoptysis, pneumothorax, CF related diabetes, ABPA and cancer. Papers on lung transplantation focus on models able to improve the selection criteria for transplantation candidates and the factors linked to post transplantation survival. Finally, several studies deal with a number of interesting topics related to CF epidemiology: clinical trial methodology, quality of care comparison among countries and centers, relationship between diagnosis and age/gender, and evaluation of pharmacological therapy. On the whole, CF Registries have already contributed to important advances in the knowledge of the natural history of CF, establishing the foundations for future improvement in CF research and care.
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Simcox AM, Duff AJA, Morton AM, Edenborough FP, Conway SP, Hewison J. Decision making about reproduction and pregnancy by women with cystic fibrosis. Br J Hosp Med (Lond) 2010; 70:639-43. [PMID: 20081591 DOI: 10.12968/hmed.2009.70.11.45053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With significant improvements in longevity, women with cystic fibrosis are increasingly likely to consider pregnancy and parenthood. This article reviews the literature relating to medical and psychosocial research that informs the decision-making process these women undertake.
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Affiliation(s)
- A M Simcox
- Institue of Health Sciences, School of Medicine, University of Leed, Leeds
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Abstract
Cystic Fibrosis (CF) is the most common life-shortening recessive genetic disease in the UK. Far from being a condition managed exclusively by paediatricians with sufferers dying in early childhood, CF is now a condition in which adults outnumber children with the condition, and the death of a child in a paediatric centre is rare. As increasing numbers of young people grow up relatively healthy it is unsurprising they begin to ask about relationships, sex, fertility and the possibility of having a child. This paper briefly describes the genetics, pathophysiology and clinical features of CF with an emphasis on how it pertains to female reproduction. The management of women with CF considering having a baby including contraception, preparation for pregnancy, the pregnancy itself, delivery and the post natal period will be discussed. Contraindications to pregnancy, method of termination, and pregnancy after transplantation will also be considered. Much of the detailed management is given in the European Guidelines for the Management of Pregnancy in Women with CF on which this paper is based.
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Popli K, Stewart J. Infertility and its management in men with cystic fibrosis: review of literature and clinical practices in the UK. HUM FERTIL 2009; 10:217-21. [DOI: 10.1080/14647270701510033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Popli K, Bourke S, Stewart J. Fertility issues in men with cystic fibrosis: survey of knowledge and opinion of patients. Fertil Steril 2008; 91:1297-8. [PMID: 18851849 DOI: 10.1016/j.fertnstert.2008.01.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Revised: 01/11/2008] [Accepted: 01/11/2008] [Indexed: 10/21/2022]
Abstract
From previous studies it is known that awareness of fertility problems in men with cystic fibrosis is improving, but little is known about their awareness of fertility treatment and the factors that influence their decision to have children. A survey was conducted to assess these issues. It was observed that very few men embarked on fertility treatment and that there was a scope of improvement in provision of reproductive, genetic, and psychologic counseling to these patients.
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Affiliation(s)
- Kiran Popli
- Newcastle Fertility Centre at Life, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom.
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Sueblinvong V, Whittaker LA. Fertility and pregnancy: common concerns of the aging cystic fibrosis population. Clin Chest Med 2007; 28:433-43. [PMID: 17467558 DOI: 10.1016/j.ccm.2007.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to dramatically improved survival, cystic fibrosis (CF) is now considered a chronic disease of adults. Many men and women who have CF are interested in starting families and have questions regarding fertility and pregnancy, making discussion of these issues important in routine CF care. This article addresses key issues of fertility in men and women who have CF and discusses pregnancy, including maternal and fetal outcomes, highlighting advances over the last decade.
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Affiliation(s)
- Viranuj Sueblinvong
- Division of Pulmonary and Critical Care Medicine, The University of Vermont and Fletcher Allen Health Care, 149 Beaumont Avenue, Burlington, VT 05405, USA.
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Wexler ID, Johannesson M, Edenborough FP, Sufian BS, Kerem E. Pregnancy and Chronic Progressive Pulmonary Disease. Am J Respir Crit Care Med 2007; 175:300-5. [PMID: 17110647 DOI: 10.1164/rccm.200605-598oe] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Progressive pulmonary disease may preclude the option of pregnancy for a number of women in their child-bearing years due to the severity of the disease. For a subset of women with chronic lung disease including cystic fibrosis, pregnancy is possible, but can have a devastating effect both on the prospective mother and fetus. The potential hazards of pregnancy in cystic fibrosis or other progressive pulmonary diseases may trigger a moral conflict between physician and patient. The female patient may argue that her autonomy cannot be circumscribed and that the physician is obliged to assist her reproductive efforts. The physician can counter that his/her participation in potentially harmful interventions is not consistent with professional norms requiring adherence to the principles of beneficence and nonmaleficence. Whenever possible, the ethical conflict between physician and patient should be resolved before initiation of pregnancy. We propose that this best be done through structured negotiations between physician and patient with the goal of constructing an ethical framework for reducing the moral tension between the two. Steps in the negotiating process include defining the therapeutic alliance, information exchange, dialog, and deliberation. As part of the information exchange, it is important to discuss alternatives to pregnancy such as adoption and surrogacy, especially when there are strong contraindications to pregnancy. If negotiations reach a satisfactory conclusion for both sides, there should be a well-delineated consensual agreement to commence the pregnancy with the full support of the medical team.
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Affiliation(s)
- Isaiah D Wexler
- Department of Pediatrics and CF Center, Hadassah University Hospital-Mount Scopus Campus, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Sims EJ, Clark A, McCormick J, Mehta G, Connett G, Mehta A. Cystic fibrosis diagnosed after 2 months of age leads to worse outcomes and requires more therapy. Pediatrics 2007; 119:19-28. [PMID: 17200267 DOI: 10.1542/peds.2006-1498] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Newborn screening for cystic fibrosis remains controversial because improved pulmonary function has not been established. Studies to date have not accounted for differences in treatments delivered to clinically diagnosed children and newborn-screened controls. Here, we compare outcomes and treatment of patients clinically diagnosed within the newborn-screening reporting window (early-clinically diagnosed), those presenting after this period (late-clinically diagnosed), and patients diagnosed by newborn screening. PATIENTS AND METHODS In a cross-sectional analysis of cohorts retrospectively ascertained, patients who were homozygous deltaF508 with cystic fibrosis, attending specialist cystic fibrosis centers, and 1 to 10 years of age between 2000 and 2002 were identified from the United Kingdom Cystic Fibrosis Database and stratified into newborn-screened, early-clinically diagnosed, or late-clinically diagnosed cohorts. Two analyses were performed: (1) after restricting to the most recent year of data collection, early-clinically diagnosed and late-clinically diagnosed cohorts were matched to newborn-screened patients by patient age and year of data collection (133 patients per cohort were identified); and (2) for all years of data collection, annual sets of data for early-clinically diagnosed and late-clinically diagnosed patients were matched to newborn-screened patients by patient age and year of data collection (291 data sets per cohort were identified). Median height and weight z scores, proportion of patients with height and weight <10th percentile, prevalence of chronic Pseudomonas aeruginosa infection, Shwachman-Kulczyki morbidity scores, percent predicted forced expiratory volume in 1 second, and numbers of long-term therapies were compared. RESULTS In both analyses, newborn screening was associated with higher height z score, higher Shwachman-Kulczyki score, lower likelihood of height <10th percentile, and fewer long-term therapies compared with late-clinically diagnosed patients. No other differences were found. CONCLUSIONS Newborn screening was associated with improved growth, reduced morbidity, and reduced therapy, yet generated equivalent pulmonary outcome compared with late clinical diagnosis, suggesting that newborn screening may slow cystic fibrosis lung disease progression.
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Affiliation(s)
- Erika J Sims
- United Kingdom Cystic Fibrosis Database, Division of Maternal and Child Health Sciences, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, United Kingdom.
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Duguépéroux I, Hubert D, Dominique S, Bellis G, De Braekeleer M, Durieu I. Paternity in men with cystic fibrosis: a retrospective survey in France. J Cyst Fibros 2006; 5:215-21. [PMID: 16627013 DOI: 10.1016/j.jcf.2006.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 02/17/2006] [Accepted: 03/08/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because more patients reach adulthood, new questions as "what about having a child and/or paternity responsibility?" arose. METHOD We performed a retrospective investigation based on the French CF registry. The context of the paternity and the health status of fathers were recorded. A comparison with clinical status of non-father patients and a compilation of follow-up data to evaluate its impact were done. RESULTS Forty-eight men had 69 children. One fourth was said to be natural conceptions, 69% needed assisted reproduction techniques. No child had CF. Clinical status of men was satisfactory: mean BMI was 20.9 kg/m(2) and mean FEV(1) and FVC were 50.5% and 69.2% of predicted, respectively. When matched to CF non-fathers, few significant differences appeared. More non-fathers were F508del/F508del (p=0.03). Fathers' sputum cultures were positive for non-Pseudomonas aeruginosa strain (p=0.05), including Staphylococcus aureus (p=0.01). Mean age at diagnosis was higher, and based on minor evidence of sterility as first symptom leading to the diagnosis of CF (p=0.01) or aspergillosis (p=0.03). The 3-year follow-up showed no degradation of the clinical status. CONCLUSION Men having paternity responsibility over children did not differ from the CF male population and neither did it seem to have an impact on the disease course.
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Affiliation(s)
- Ingrid Duguépéroux
- Service de Cytogénétique, Faculté de Médecine et des Sces de la Santé, UBO and CHU Morvan, 29388 Brest, France
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Hubert D, Patrat C, Guibert J, Thiounn N, Bienvenu T, Viot G, Jouannet P, Epelboin S. Results of assisted reproductive technique in men with cystic fibrosis. Hum Reprod 2006; 21:1232-6. [PMID: 16431902 DOI: 10.1093/humrep/dei453] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sterility in men with cystic fibrosis (CF) raises the question of the use of assisted reproductive techniques (ART). A multidisciplinary network including adult CF centre and reproductive medicine units was set up to answer requests for ART. METHODS This retrospective study included 25 men with CF between 1994 and 2004. Clinical status, semen analysis, CF mutations analysis and artificial insemination by donor (AID) or ICSI after surgical retrieval of sperm were monitored. RESULTS All CF men had azoospermia. Two chose AID first (one delivery); 23 chose ICSI. Sperm were surgically retrieved in 21 cases, and ICSI was performed in 19. Pregnancies occurred in 12 of these 19 couples (63%) (two ectopic pregnancies, two spontaneous abortions, one termination of pregnancy for polymalformed twins and 11 single deliveries in nine couples). Two couples tried AID after ICSI failed; one had twins. Another adopted a child, and two had a spontaneous pregnancy. After a follow-up of 4.1+/-2.3 years, two patients died, two underwent lung transplantation and 21 remained stable. CONCLUSION ART can help men with CF to become a father, but their health status and short survival need careful counselling and multidisciplinary medical care.
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Affiliation(s)
- Dominique Hubert
- Centre de Ressources et de Compétences pour la Mucoviscidose - Service de Pneumologie, Paris, France
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Sims EJ, Green MW, Mehta A. Decreased lung function in female but not male subjects with established cystic fibrosis-related diabetes. Diabetes Care 2005; 28:1581-7. [PMID: 15983304 DOI: 10.2337/diacare.28.7.1581] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although cystic fibrosis-related diabetes (CFRD) is associated with decreased lung function, sex is not known to influence CFRD. However, compared with male subjects with cystic fibrosis, female subjects with cystic fibrosis have increased morbidity. This study examines the association between female subjects with CFRD and poor lung function relative to male subjects using the percent predicted forced expiratory volume in 1 s (FEV(1)) as a surrogate measure of morbidity. RESEARCH DESIGN AND METHODS We compared 323 patients with established CFRD with 489 cystic fibrosis control subjects with normal glucose tolerance (NGT) listed in the U.K. Cystic Fibrosis Database. Patients stratified by sex and chronic Pseudomonas aeruginosa infection were compared using binary logistic regression, and patients with new CFRD diagnoses were compared prospectively for the year 2002. RESULTS CFRD in female subjects (but not male subjects) without chronic P. aeruginosa infection had a 20% lower percent predicted FEV(1) compared with control subjects with NGT (95% CI -11.7 to -27.7; P < 0.0001). Genotype, age, treatment center, age at diagnosis of cystic fibrosis, pregnancy, liver function, or dose of pancreatic enzyme replacement therapy did not confound this female disadvantage. Comparison of female subjects with newly diagnosed CFRD free of chronic P. aeruginosa infection with matched control subjects with NGT showed no FEV(1) disadvantage in the 1st year after CFRD diagnosis. CONCLUSIONS Only female subjects with CFRD have significantly decreased lung function compared with sex-matched NGT control subjects. The absence of poor lung function in the first 12 months after diagnosis of diabetes suggests that an opportunity may exist to intervene and possibly prevent a decline in lung function, which can be as much as 20% in female subjects with CFRD.
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Affiliation(s)
- Erika J Sims
- Division of Maternal and Child Health Sciences, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK.
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