Elexacafator/tezacaftor/ivacaftor resolves subfertility in females with CF: A two center case series

•This manuscript describes a 2-center case series of pregnancy in FwCF taking Elexacaftor/tezacaftor/Ivacaftor (ETI).•Our findings suggest increased fertility in this patient population.•Clinical care guidelines should be revised to include counseling on family planning as data emerges regarding alteration in female fertility when taking CFTR modulators. Infertility and subfertility are commonly faced by females with cystic fibrosis (FwCF) and resulting in decreased contraceptive use and increased utilization of reproductive technologies. Elexacaftor-tezacaftor-ivacaftor (ETI) is a CFTR modulator that affects common causes of subfertility. Two CF centers conducted a retrospective chart review on females with CF who were receiving ETI and became pregnant. We analyzed obstetrical-gynecological history, genotype, and clinical response to ETI therapy. Fourteen FwCF on ETI became pregnant. Half (7) of the FwCFs were previously attempting to conceive, but only three were using contraceptives. Four FwCF had a history of infertility; two were reconsidering use of reproductive technologies (IUI). Patients achieved conception at mean 8 weeks after initiating ETI. ETI may lessen CF-associated factors that affect fertility; however, its exact mechanism is unknown. This warrants counseling on contraceptive use and family planning prior to initiation of therapy and at routine intervals while utilizing ETI.