Ovarian reserve in nigerian women with sickle cell anaemia: a cross- sectional study

Garba, Sunusi Rimi; Makwe, Christian Chigozie; Osunkalu, Vincent Oluseye; Kalejaiye, Olufunto Olufela; Soibi‐Harry, Adaiah; Aliyu, Amina Umar; Afolabi, Bosede B

doi:10.1186/s13048-021-00927-5

Cited by 15 publications

(11 citation statements)

References 19 publications

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“…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 ). Females with SCD develop diminished ovarian reserve (DOR) at younger ages (25-30 years) than age-matched women ( 33 , 34 ).…”

Section: Impact Of Hemoglobinopathies On Fertilitymentioning

confidence: 99%

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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Section: Impact Of Hemoglobinopathies On Fertilitymentioning

confidence: 99%

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

et al. 2022

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“…Age-based thresh olds for infer til ity diag no sis may not apply to women with SCD, who have a sharper tra jec tory of decline in ovar ian reserve. [18][19][20][21][22] At Johns Hopkins, we offer repro duc tive endo cri nology and infer til ity (REI) spe cial ist con sul ta tion to women who have attempted to con ceive for 6 months or lon ger. Helping patients know when to seek care can help with timely REI referral; rec og nized bar ri ers to infer til ity care make atten tion to referral tim ing espe cially impor tant.…”

Section: Learning Objec Tivesmentioning

confidence: 99%

“…25 This helps explain why age-asso ci ated decline in ovar ian reserve appears to be accel er ated in women with SCD (Figure 2). [18][19][20][21] In a small study of women with sickle cell ane mia (SCA), men o pause occurred ear lier than the gen eral pop u la tion. 26 This might be expected in a dis ease asso ci ated with accel er ated aging and sup ports the hypoth e sis that women with SCD have a narrower repro duc tive win dow than unaf fected women.…”

Section: Case (Con Tin Ued)mentioning

confidence: 99%

No crystal stair: supporting fertility care and the pursuit of pregnancy in women with sickle cell disease

2022

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Growing recognition that the ovary is an end organ in sickle cell disease (SCD), advances in SCD treatment and cure, and innovations in assisted reproductive technologies invite progressive challenges in fertility care for women with SCD. The reproductive life span of women with SCD may be reduced because ovarian reserve declines more rapidly in people with SCD compared to unaffected people. Some young women have diminished ovarian reserve, a risk factor for infertility. Referrals for fertility preservation may be offered and anticipatory guidance about when to seek infertility care provided. For a subset of people with SCD, this information is also applicable when pursuing in vitro fertilization with preimplantation genetic testing to avoid implantation of an embryo with SCD. Here we explore the dimensions of SCD-related fertility care illustrated by the case of a 28-year-old woman with hemoglobin SS disease who initially presented for a hematology consultation for preconception counseling. This case highlights the complexity of preconception SCD management and care and the need to partner with patients to help align pregnancy hopes with SCD treatment and the many associated uncertainties.

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“…[7][8][9] Specifically, Garba et al found that after controlling for age and body mass index, ovarian reserve, as measured by serum anti-Mullerian hormone (AMH), was lower among those with HbSS versus HbAA. 10 Treatment for SCD may also impact fertility among women, with data to support that younger women of ages 10-24 years treated with hydroxyurea had higher rates of DOR. 11 Among males with SCD, evidence indicates that factors contributing to infertility include delayed puberty, low testosterone, and sperm abnormalities 12 due to testicular dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, Garba et al. found that after controlling for age and body mass index, ovarian reserve, as measured by serum anti‐Mullerian hormone (AMH), was lower among those with HbSS versus HbAA 10 . Treatment for SCD may also impact fertility among women, with data to support that younger women of ages 10–24 years treated with hydroxyurea had higher rates of DOR 11 .…”

Section: Introductionmentioning

confidence: 99%

Infertility and treatment‐seeking practices among females and males with sickle cell disease in the Sickle Cell Disease Implementation Consortium registry

Stevenson

Tanabe

Knisely

et al. 2023

Pediatric Blood & Cancer

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Objective To describe the prevalence of infertility and infertility treatment seeking among people enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry and identify sociodemographic and clinical correlates of infertility. Design Cross‐sectional. Participants The study population included 2108 women and men (≥18 years of age) enrolled in the SCDIC registry who completed the fertility questionnaire. Results All participants who completed the infertility‐specific questions were included in the analysis (1224 females; 884 males). Of these, 16.9% of males and 23.7% of females reported infertility, in contrast to rates in the general population (12% of males; 11% of females). Only 22.8% of this subgroup had sought a fertility consultation; of these, 41% received infertility testing and 58% received advice, yet only a few received specific treatment: ovulation medication (19.1%), fallopian tubal surgery (4.8%), other female treatment (17.5%), varicocelectomy (8.1%), or other male treatment (10.8%). Increasing age, employment status, and interaction between gender and single marital status are associated with reported infertility. We did not observe differences between groups relative to sickle cell disease (SCD) genotype, a broad category of self‐reported hydroxyurea use any time during life, type of medical insurance, income, or education. Conclusion To our knowledge, this is the first study to examine self‐reported identification of and treatment for infertility among a large sample of people with SCD. These findings suggest that (a) infertility occurs at a higher rate, but fertility care treatment seeking is less frequent than in the general public; and (b) sociodemographic and clinical differences between individuals who report experiencing infertility and those who do not did not emerge in this study.

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Ovarian reserve in nigerian women with sickle cell anaemia: a cross- sectional study

Cited by 15 publications

References 19 publications

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

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

No crystal stair: supporting fertility care and the pursuit of pregnancy in women with sickle cell disease

Infertility and treatment‐seeking practices among females and males with sickle cell disease in the Sickle Cell Disease Implementation Consortium registry

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