Family-building and parenting considerations for people with cystic fibrosis

Abstract

As people with cystic fibrosis (CF) live longer and healthier lives, increasing numbers are considering the full range of reproductive options for their futures, including parenthood, pregnancy, or pregnancy prevention. As the face of CF changes, the CF care model must adapt to meet the reproductive health needs of both parents and nonparents with CF. This article summarizes the reproductive goals and family-building concerns faced by people with CF, including fertility, pregnancy, and alternative paths to parenthood, the impact of parenthood on mental and physical health, and important future research.

Keywords: cystic fibrosis; family-building; fertility; parenthood.

Figure 1

Male and female reproductive anatomy. (A) Reproductive anatomy in people without cystic fibrosis (CF). (B) The majority of men with CF are born with congenital bilateral absence of the vas deferens (CBAVD). Although the majority of women with CF are fertile, fertility can be impaired by thickened, acidic mucus resulting from malfunctioning CF‐transmembrane conductance regulator (CFTR) in the reproductive tract [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

Common assisted reproductive technology (ART) used to achieve pregnancy includes IVF, ICSI, and IUI. Hormonal stimulation of ovarian follicle production is often combined with IVF, IUI, or artificial donor insemination. Egg retrieval is performed by using an ultrasound‐guided needle into each ovarian follicle. Traditional IVF requires a large number of sperm to be combined in vitro to fertilize an oocyte. ICSI allows one sperm alone to achieve fertilization by directly injecting it into the cytoplasm of an oocyte. Embryos or sperm are placed directly into the uterus via IUI. ICSI, intracytoplasmic sperm injection; IVF, in vitro fertilization; IUI, intrauterine insemination [Color figure can be viewed at wileyonlinelibrary.com]

Figure 3

Commonly used assisted reproductive techniques for sperm retrieval include testicular sperm extraction (TESE), testicular sperm aspiration (TESA), percutaneous epididymal extraction (PESA), and microsurgical epididymal sperm extraction (MESA). Following sperm retrieval, intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI), and in vitro fertilization (IVF) are required to achieve pregnancy [Color figure can be viewed at wileyonlinelibrary.com]

Figure 4

Paths to parenthood. While some people with cystic fibrosis will choose pregnancy to build their families, other options for family‐building include adoption (assuming the legal parenting responsibilities for a child whose parents or legal guardians are unable to care for them), step‐parenthood (assuming full or partial responsibility for a partner's children), foster care (providing a home for one or more children while their own family is temporarily unable to care for them), and surrogacy (utilizing someone else who becomes pregnant and carries a child specifically for another person) [Color figure can be viewed at wileyonlinelibrary.com]