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Managing & Digestive Problems — and in CF

PUBERTY AND FERTILITY IN CF

Puberty * is the period of time GROWTH AND DEVELOPMENT IN PUBERTY Your son or daughter may find it when a person’s body changes and Young people with CF go through hard to start puberty later than becomes sexually mature. Puberty puberty and develop into men friends and classmates. Your occurs when certain * and women just as other people may be self-conscious about being (special chemicals in the body), without CF do. Adolescents with one of the shortest kids in his or such as ,* ,* CF, however, may start puberty her class or being less developed and growth ,* are made later than other adolescents. Some than the other kids in the locker by the body. This “surge” or in - of the physical signs of growth and room. If your child is struggling crease of hormones sends signals development that may be delayed with feelings about puberty or how to the body and leads to dramatic include: he or she looks, talking with a CF physical and emotional changes. health care team member may • Getting taller or reaching close * is the stage of help your child figure out ways to to height development when puberty takes improve nutrition or general place. At no other time in a • Underarm , , and health to speed up the start of person’s life is there such intense (in boys) puberty. The CF health care team growth and development, except • Boys’ voices getting deeper and can also help reassure your child during infancy. Although we talk their genitals * growing larger that the time will come for him about “reaching puberty,” it • developing and or her to go through puberty—it doesn’t happen overnight— beginning to have menstrual will happen. puberty is actually a process that periods * or menses * takes three to five years. No two When puberty starts may depend MALE FERTILITY adolescents * go through puberty on the overall health of a person. During puberty, boys with CF exactly the same way nor do they A person with CF who is under - develop normal physical sexual reach puberty at the same age. weight, for example, or who has features. They produce sex Although changes in the body are severe lung disease may go hormones and have normal sexual most noticeable, an adolescent’s through puberty later than other drives. More than 90 percent is maturing during puberty adolescents with CF. Severely of men with CF, however, are as well, and will continue to underweight girls may begin their infertile * and cannot make a mature after the body is fully periods even later, or their periods female pregnant. Being infertile developed. With these brain may not follow a regular cycle. does not mean that a is and body changes in puberty, Having enough body fat helps impotent (unable to have sexual adolescents’ interests change and puberty start on time. Adolescents intercourse *). Men with CF can most become more focused on with CF who have good nutrition have and dating, relationships, appearance, will usually have a normal growth produce * like other young and sexuality. spurt. However, some children men. But in CF the tube that carries the sperm from the testes A person normally becomes with CF, even when well-nourished, tend to start puberty late. A reason to the seminal vesicles * (called fertile * during puberty. Fertility * the vas deferens *) is blocked or is a ’s ability to conceive * for this may be how a person with CF makes and uses growth absent. When the vas deferens is (become pregnant) or a man’s absent, it is called congenital ability to bring about conception * hormones. If your child does not show any signs of puberty by age bilateral absence of the vas (getting someone pregnant). deferens * (CBAVD). If a man Sometimes certain conditions 14 for boys (an increase in size of the testes * is the first sign) and age has CBAVD, his * (the fluid or diseases can affect the onset of ejaculated * from the penis * when puberty. Cystic fibrosis * (CF *) can 13 for girls ( development is the first sign), talk with your sexually stimulated) contains no affect the timing of puberty and sperm. For to occur, a fertility in both males and females. doctor. Your child may need to see a pediatric endocrinologist ,* man’s sperm cell * must meet a a doctor who specializes in hormone problems.

*See CF Words to Know Glossary . Cystic Fibrosis Family Education Program … 1 Managing Nutrition & Digestive Problems — Puberty and Fertility in CF

woman’s cell. To know abnormally thick. Very thick severe lung disease may not have whether a man is infertile, the mucus makes it hard for a male’s enough lung function to have a doctor can do a “sperm count” on sperm to get through the to healthy pregnancy. In this case, semen ejaculated from the penis. meet the egg. Also, women with CF pregnancy could put both the A man with CF can talk with his who are very underweight can woman and her baby at risk. doctor about having this test. Up have less frequent and less regular Some women with CF develop to 5 percent of men with CF do , making it more difficult diabetes * ( sugar * have sperm in their semen and to get pregnant. problems) during pregnancy and can father children naturally. PREGNANCY need to control it for their health New medical techniques allow and their babies’ health. If a Getting Ready for Pregnancy some men with CBAVD to father woman with CF is pregnant, she When a woman with CF is children. There is now a way to needs to get medical care from an considering having a baby, she get the sperm from the testes and obstetrician * (OB) who specializes fertilize * the egg from a female. should talk with her CF doctor in high-risk . A high- A fertility specialist * can give about the risks, and look at her risk obstetrician can help treat lung function * and weight men with CF more information current diabetes in pregnancy and can to see if she can have a healthy about how it is done and the help prevent or treat other pregnancy. Ideally, a woman with success rate. health problems related to CF should be at or close to her the pregnancy. FEMALE FERTILITY ideal body weight before getting In puberty, females begin to pregnant. A woman with CF has to Besides seeing the obstetrician, * menstruate * (monthly flow of take in an extra 300 calories pregnant women with CF should every day and gain about 20 blood). Menstrual cycles * usually continue to see their CF health last 28 to 31 days, but they can pounds during a pregnancy to care team for regular CF care. vary from woman to woman and ensure normal growth of the baby. PASSING ON THE CF from month to month. During the Being at one’s ideal body weight Along with planning a pregnancy first half of the cycle, the * reduces the risk of having a prepares itself for pregnancy by premature baby or needing a like other parents, people with CF cesarean section * (surgery) to building up extra tissue. If the have other things to think about, deliver the baby. woman does not get pregnant such as: What is the possibility I could pass the CF gene * on to my during this time, the uterus Certain medications could put child? And, what are the chances releases or sheds this extra tissue the developing baby at risk; my child will have CF? When a and some blood. This release is therefore, the CF health care team person with CF has a child, the called having a menstrual period may need to change some of the baby will get a CF gene from the or menses. After the menses is woman’s CF medicines she before parent with CF. The child will over (usually in 4 to 7 days), the gets pregnant. either be a carrier * of the CF gene begins again. Health Risks with Pregnancy or will have CF. Whether the child Once they have had their first Pregnancy can be more risky in is a carrier or has CF depends on period (menses), many females women with CF who have lung the other parent. Remember, a with CF are able to get pregnant. problems. Pregnancy can some - person has to inherit * two CF Some women with CF do have times lead to more lung problems. to have the disease. children of their own. Others, When a woman with CF is Here are the possibilities: however, have problems getting pregnant, it is important for pregnant. Although ovulation * her to watch for signs of * • When the other parent is a CF (release of from the *) and to take action to prevent carrier (has one CF gene), the occurs normally in CF, the mucus * lung problems with treatments child has one chance in two in the woman’s cervix * can be (airway clearance * and breathing (50%) of having CF. treatments *). A woman who has

2 … Cystic Fibrosis Family Education Program *See CF Words to Know Glossary . Managing Nutrition & Digestive Problems — Puberty and Fertility in CF

INHERITING CF: PARENT WITH CF AND PARENT CARRYING CF GENE exam * before starting and talk with her doctor about the risks of each type of birth control method. For example, birth control pills may cause an increase in blood sugar levels if a woman has CF-related diabetes (CFRD) .* Birth control pills may also have drug interactions with certain antibiotics * or other Has CF Carrier medicines. Keep in mind that abstinence (not having sexual intercourse) is 100 percent effective for both protecting against sexually transmitted diseases * (STDs, sometimes called sexually transmitted or STIs) and preventing pregnancy.

SEXUALLY TRANSMITTED DISEASES Has CF Has CF Carrier Carrier Whether or not a man or woman with CF is fertile, he or she can still get and pass on an STD. Sexually transmitted diseases are infections • When both parents have CF, contraception ,* is used to prevent passed from one person to another every child they conceive will pregnancy. Several methods of through sexual activity. Examples have CF. birth control are available: of STDs include chlamydia, HPV • When the other parent does not • Hormone methods, such as pills, ( papillomavirus), syphilis, have CF and is not a CF carrier a patch, or a device that and gonorrhea. Other infections (has no CF genes), the child will goes in the * (vaginal that can be passed from person be a carrier of the CF gene but ring) or uterus (intrauterine to person through sexual activity will not have CF. device or IUD) include infectious hepatitis, human It is very important that a person • Barrier methods that keep immunodeficiency virus or HIV with CF have his or her partner sperm from getting to the egg, (the virus that causes AIDS), and tested to see if the partner is a such as condoms, a diaphragm herpes. Often people cannot tell if carrier for any CF gene. Prenatal * (a special cap that is put into the their partners have an STD by just testing of the unborn baby (done vagina to cover the cervix), or a looking at them. Many times people during pregnancy) can usually tell copper IUD are infected without knowing it, but whether the baby has CF. For more • Surgery to permanently prevent these infections can cause serious information, see “ THE GENETICS OF pregnancy, such as a tubal health problems. ligation (the fallopian tubes * CF” in the appendix of the CF FEP The best protection from STDs, of a woman are tied so that the module Beginning CF Care and talk of course, is to not be sexually eggs cannot pass through the to the CF health care team. active. If a person is sexually tubes to the sperm) active, condoms can help protect BIRTH CONTROL AND CF Before becoming sexually active, against STDs. To be protected, Women with CF who do not want a woman with CF should talk with a couple has to use a condom to get pregnant need to either her CF doctor or gynecologist * every time they have intercourse not have sexual intercourse (doctor who specializes in (sex). There is no “safe” sex, just (abstinence *) or use some form women’s health) about using birth “safer” sex. of birth control. Birth control, or control. She should have a pelvic

*See CF Words to Know Glossary . Cystic Fibrosis Family Education Program … 3