Diminished ovarian reserve in young women with sickle cell anemia

Pecker, Lydia H.; Hussain, Sarah; Mahesh, Jaanvi; Varadhan, Ravi; Christianson, Mindy S.; Lanzkron, Sophie

doi:10.1182/blood.2021012756

Cited by 31 publications

(39 citation statements)

References 27 publications

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“…[46][47][48][49] Subfertility and premature ovarian failure in women with SCD could also account for lower pregnancy rates with older age; thus, studies on fertility preservation and non-gonadotoxic therapies for SCD should remain a high research priority. 10,46,50 Lastly, cumulative end-organ damage and decreased median survival may prematurely truncate the reproductive lifespan of women living with SCD. 3,4 Of note, we Primary C-section rates increased in Black women with SCD across each 10-year era of our study, though this increase did not significantly differ from that of primigravid Black women without SCD.…”

Section: Resultsmentioning

confidence: 99%

“…Lastly, we included the Distressed Communities Index (DCI), which compares the economic well-being of communities across the US using a weighted average of seven populations-based metrics derived from zip code level data, then normalizes that value into a single summary statistic (or DCI score) ranging from 0 to 100. 42 We assigned each woman's DCI score based on her residential zip code at time of delivery as reported in the PDD or EDU, then categorized them into 1 of 5 predefined economic groups: prosperous (0-20), comfortable (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40), mid-tier (41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60), at-risk (61-80), and distressed (81-100).…”

Section: Covariate Descriptionsmentioning

confidence: 99%

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Pregnancy outcomes in women with sickle cell disease in California

et al. 2023

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Adverse pregnancy outcomes occur frequently in women with sickle cell disease (SCD) across the globe. In the United States, Black women experience disproportionately worse maternal health outcomes than all other racial groups. To better understand how social determinants of health impact SCD maternal morbidity, we used California's Department of Health Care Access and Information data (1991–2019) to estimate the cumulative incidence of pregnancy outcomes in Black women with and without SCD—adjusted for age, insurance status, and Distressed Community Index (DCI) scores. Black pregnant women with SCD were more likely to deliver at a younger age, use government insurance, and live in at‐risk or distressed neighborhoods, compared to those without SCD. They also experienced higher stillbirths (26.8, 95% confidence interval [CI]: 17.5–36.1 vs. 12.4 [CI: 12.1–12.7], per 1000 births) and inpatient maternal mortality (344.5 [CI: 337.6–682.2] vs. 6.1 [CI: 2.3–8.4], per 100 000 live births). Multivariate logistic regression models showed Black pregnant women with SCD had significantly higher odds ratios (OR) for sepsis (OR 14.89, CI: 10.81, 20.52), venous thromboembolism (OR 13.60, CI: 9.16, 20.20), and postpartum hemorrhage (OR 2.25, CI 1.79–2.82), with peak onset in the second trimester, third trimester, and six weeks postpartum, respectively. Despite adjusting for sociodemographic factors, Black women with SCD still experienced significantly worse pregnancy outcomes than those without SCD. We need additional studies to determine if early introduction to reproductive health education, continuation of SCD‐modifying therapies during pregnancy, and increasing access to multidisciplinary perinatal care can reduce morbidity in pregnant women with SCD.

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Section: Resultsmentioning

confidence: 99%

Section: Covariate Descriptionsmentioning

confidence: 99%

Pregnancy outcomes in women with sickle cell disease in California

et al. 2023

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“…Women with SCD have multiple risks for reduced ovarian reserve: chronic inflammation, oxidative stress, and ovarian ischemia and reperfusion injuries ( 30 , 31 ). Three studies have demonstrated normal anti-müllerian hormone (AMH) levels in untreated adolescent and young adults with SCD ( 32 – 34 ). However, women with SCD experience a more rapid decline in ovarian reserve, with lower levels of AMH than age matched controls ( 33 , 35 , 36 ).…”

Section: Impact Of Hemoglobinopathies On Fertilitymentioning

confidence: 99%

“…However, women with SCD experience a more rapid decline in ovarian reserve, with lower levels of AMH than age matched controls ( 33 , 35 , 36 ). Females with SCD develop diminished ovarian reserve (DOR) at younger ages (25-30 years) than age-matched women ( 33 , 34 ). Yet, no studies to date define the definitive risk of infertility in this population ( 28 ).…”

Section: Impact Of Hemoglobinopathies On Fertilitymentioning

confidence: 99%

“…No patient receiving hydroxyurea in this study met criteria for premature ovarian insufficiency as defined as FSH is > 40 IU/L ( 32 ). In another single center analysis of ovarian reserve in 26 women with sickle cell anemia, all (n=5) women diagnosed with DOR were taking hydroxyurea ( 34 ). Whether markers of ovarian reserve normalize when hydroxyurea is stopped and whether hydroxyurea impairs fertility, ovarian hyperstimulation, or oocyte quality is not established.…”

Section: Palliative and Disease Modifying Therapies As Potential Infe...mentioning

confidence: 99%

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Fertility preservation for pediatric patients with hemoglobinopathies: Multidisciplinary counseling needed to optimize outcomes

et al. 2022

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Hemoglobinopathies are autosomal recessive disorders that occur when genetic mutations negatively impact the function of hemoglobin. Common hemoglobinopathies that are clinically significant include sickle cell disease, alpha thalassemia, and beta thalassemia. Advancements in disease-modifying and curative treatments for the common hemoglobinopathies over the past thirty years have led to improvements in patient quality of life and longevity for those who are affected. However, the diseases, their treatments and cures pose infertility risks, making fertility preservation counseling and treatment an important part of the contemporary comprehensive patient care. Sickle cell disease negatively impacts both male and female infertility, primarily by testicular failure and decreased ovarian reserve, respectively. Fertility in both males and females with beta thalassemia major are negatively impacted by iron deposition due to chronic blood transfusions. Hematopoietic stem cell transplant (HSCT) is currently the only curative treatment for SCD and transfusion dependent beta thalassemia. Many of the conditioning regimens for HSCT contain chemotherapeutic agents with known gonadotoxicity and whole-body radiation. Although most clinical studies on toxicity and impact of HSCT on long-term health do not evaluate fertility, gonadal failure is common. Male fertility preservation modalities that exist prior to gonadotoxic treatment include sperm banking for pubertal males and testicular cryopreservation for pre-pubertal boys. For female patients, fertility preservation options include oocyte cryopreservation and ovarian tissue cryopreservation. Oocyte cryopreservation requires controlled ovarian hyperstimulation (COH) with ten to fourteen days of intensive monitoring and medication administration. This is feasible once the patient has undergone menarche. Follicular growth is monitored via transvaginal or transabdominal ultrasound, and hormone levels are monitored through frequent blood work. Oocytes are then harvested via a minimally invasive approach under anesthesia. Complications of COH are more common in patients with hemoglobinopathies. Ovarian hyperstimulation syndrome creates a greater risk to patients with underlying vascular, pulmonary, and renal injury, as they may be less able to tolerate fluids shifts. Thus, it is critical to monitor patients undergoing COH closely with close collaboration between the hematology team and the reproductive endocrinology team. Counseling patients and families about future fertility must take into consideration the patient’s disease, treatment history, and planned treatment, acknowledging current knowledge gaps.

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Sickle cell haemoglobin and its interactions with other variant haemoglobins and with thalassaemias

2024

Haemoglobinopathy Diagnosis

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Diminished ovarian reserve in young women with sickle cell anemia

Cited by 31 publications

References 27 publications

Pregnancy outcomes in women with sickle cell disease in California

Pregnancy outcomes in women with sickle cell disease in California

Fertility preservation for pediatric patients with hemoglobinopathies: Multidisciplinary counseling needed to optimize outcomes

Sickle cell haemoglobin and its interactions with other variant haemoglobins and with thalassaemias

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