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For much of the history of cystic fibrosis (CF) care, reproductive health was not a major part of the conversation. Fertility challenges were the norm for men and women with this genetic disorder, and many grew up assuming biological parenthood was not possible.

Clinical visits often focused on more immediate concerns: How is your lung function? Is your weight holding steady? Are symptoms affecting your ability to get through the day?

Today, these conversations look markedly different. The introduction of cystic fibrosis transmembrane conductance regulator (CFTR) modulators has transformed the quality of life for many patients with CF. They are living longer, healthier lives, and for many of them, having biological children has become a realistic option.

One of the most striking changes has been in fertility among women with CF. After the approval of the triple-combination modulator elexacaftor/tezacaftor/ivacaftor (Trikafta) in 2019 in the U.S. and in 2020 in the U.K., pregnancy rates nearly doubled in those countries. Women who once faced fertility challenges are beginning to conceive naturally, often to their surprise.

Clinicians suddenly found themselves navigating questions that previous generations of CF providers rarely encountered. In response, the Cystic Fibrosis Foundation convened a multidisciplinary group of specialists from around the world to develop the first clinical set of guidance for reproductive health care throughout the lifespan.

I was the corresponding author for this guide, published in August 2026 in The Lancet Respiratory Medicine , that recommends providing age-appropriate education early and discussing reproductive health at least annually starting in the teen years.

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