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FERTILITY IN CF
5
FERTILITY IN
CYSTIC FIBROSIS
Dr Cathy Baird
Netcare Milpark Hospital
Charlotte Maxeke Johannesburg Hospital
SEXUALITY
SEXUALITY
Tempting to minimise disease.
Risk taking may be more.
CF individuals are no different when it comes to sexual education
MALE
SEXUAL FUNCTION
Thinner ejaculate
Lower semen volume
Normal testosterone
Normal errection
Normal ejaculation
SEXUAL FUNCTION
FERTILITY
TSE
FERTILITY
ART
MESA
PESA
ICSI
FEMALE
FEMALE
CONTRACEPTION
? PORT
Subdermal injectable device - 3 years
CONTRACEPTION
Combined oral contraceptive pill
Intrauterine contraceptive device - 5 years
Transdermal contraceptive patch
Intramuscular injectable progesterone
Vaginal ring
Barrier contraception
FERTILITY
REDUCED FERTILITY
? Thick cervical mucous
Irregular periods or the absensce of periods when ill
Poor health status - FEV1 < 50%, poor BMI, respiratory failure
INCREASED FERTILITY
Improved health
Assisted reproduction techniques are available
Surrogacy is more available
Adoption and fostering
PREGNANCY
PLAN
with the CF team
GENOTYPING
AND
GENETIC COUNSELLING
GENOTYPING
AND
GENETIC COUNSELLING
Patient and partner
OPTIMISE
OPTIMISE
Nutrition
Respiratory care
REVIEW MEDICATION
REVIEW MEDICATION
Stop all OTC and herbal medication
Continue Vitamin A, D, E & K (monitor levels)
Discuss future management of exacerbations
Which CF medications and investigations should be avaoided and when?
Aminoglycosides? Ciprofloxacin? Kalydeco? Orkambi? Radiographic investigations?
DISCUSSION ABOUT THE DIFFICULT REALITIES OF CF
DISCUSSION ABOUT THE DIFFICULT REALITIES ...
Additional support to continue therapies
One parent family
Reduction of work hours
Financial burden and planning
1.6L
1.6L
FEV1 = 70-100% OF EXPECTED
FEV1 = 40-70% OF EXPECTED
FEV1 = 0-40% OF EXPECTED
RISKS TO THE FOETUS
Prematurity
No delayed foetal growth
No increased in foetal anomalies
RISKS TO THE MOTHER
DURING PREGNANCY
Diabetes - OGTT at 12-16 weeks and 24-28 weeks
Poor weight gain / nutritional loss
AFTER PREGNANCY
Increased admissions and iv antibiotics
RISKS AFTER LUNG TRANPLANT
RISK TO THE FOETUS
Increased risk of prematurity
Low birth weight
Increase risk of foetal anomalies with some immune supressive therapy
RISK TO THE MOTHER
Increased risk of prenancy complications
Increased risk of acute rejection
AFTER PREGNANCY
PARENTING
PARENTING
THE CHILDREN OF CF PARENTS
THE CHILDREN OF
CF PARENTS
The children of CF parents needs long term support and follow up