Ovarian Reserve in Women with Cystic Fibrosis: Is this a Common Cause of Subfertility?

Keren Marks-Garber 1,2 Malena Cohen-Cymberknoh 3 Joel Reiter 3 Aielet Stolovas 3 Chana Adler Lazarovits 1,2 Efrat Esh Broder 1,2 Anat Hershko Klement 1,2
1The IVF unit, Hadassah University Hospital, Israel
2Medical school, The Hebrew University, Israel
3The Pediatric Pulmonology Unit and Cystic Fibrosis Center, Hadassah University Hospital, Israel

Introduction:
Currently, most patients with Cystic fibrosis (CF) survive into adulthood and are interested in reproduction. Subfertility in CF female patients remains high, with multi-factorial etiologies. Till now, knowledge regarding ovarian reserve is limited and is based on a single publication demonstrating a reduced ovarian reserve.

Aim:
To assess ovarian reserve in CF patients and to correlate to CF disease severity.

Methods:
Patients in the reproductive age-span were recruited from the CF Center at Hadassah Medical Center in Jerusalem. AFC and serum AMH levels were measured. Data regarding menstrual, obstetric and fertility history were recorded, as well as CFTR-class mutations, BMI, pancreatic status, spirometry values, laboratory data and daily therapies.

Results:
Twenty female patients (19-40 years,median 27) were recruited. 13/20 reported relationship, 9/13 achieved at least one live birth and 5/13 (38%) required fertility treatments. Median AFC value was 13.5 and median AMH 2.3 ng/ml (range 0.09- 6.47). Nine patients presented AMH 0.5, and >0.5 respectively). No association was found between therapies, including the new modulators, and levels of AMH and/or AFC.

Conclusions:
Contrary to the limited information, our CF cohort does not present a reduced ovarian reserve. Further studies are needed in order to better understand the causes of subfertility in women with CF, and whether CFTR modulators influence fertility.