Risks associated with fertility preservation for women with sickle cell anemia

Abstract

Women with SCA may choose to undergo diverse FPT strategies before HSCT and are at risk for serious SCA-related complications. Evidence-based strategies to mitigate SCA-related morbidity and to optimize fertility preservation outcomes are needed.

Consequences of β-Thalassemia or Sickle Cell Disease for Ovarian Follicle Number and Morphology in Girls Who Had Ovarian Tissue Cryopreserved

“…Hereby, illustrating that OTC can regain ovarian function in these patient groups. A total of 15 oocyte/embryo cryopreservations have been reported in SCD, with no reported transfers so far ( 9 , 57 , 59 , 60 ), making it difficult to evaluate this fertility preserving strategy. Women with SCD undergoing ovarian stimulation prior to oocyte and embryo cryopreservation have an increased risk of ovarian hyperstimulation syndrome (OHHS), thrombosis, vaso-occlusive events, and painful crises ( 9 , 57 , 59 , 60 ), all complications which may favor OTC.…”

“…A total of 15 oocyte/embryo cryopreservations have been reported in SCD, with no reported transfers so far ( 9 , 57 , 59 , 60 ), making it difficult to evaluate this fertility preserving strategy. Women with SCD undergoing ovarian stimulation prior to oocyte and embryo cryopreservation have an increased risk of ovarian hyperstimulation syndrome (OHHS), thrombosis, vaso-occlusive events, and painful crises ( 9 , 57 , 59 , 60 ), all complications which may favor OTC. However, SCD patients have an increased risk of severe pulmonary complications during general anesthesia, which can lead to multi-organ failure and death ( 61 , 62 ), which has to be considered before deciding on which fertility preserving strategy to use.…”

Hydroxycarbamide exposure and ovarian reserve in women with sickle cell disease in the Multicenter Study of Hydroxycarbamide

“…The presence of normal AMH in two small, HC‐naïve populations with sickle cell anaemia suggests that the disease alone may not reduce ovarian reserve in young women. Further clarification of the effects of HC on ovarian reserve will be especially important for the emerging generation of young adults who started HC in infancy or early childhood, 33,34 for girls and women treated in sub‐Saharan Africa where both fixed‐dose and maximally tolerated dose treatment strategies are under investigation, 35 and in women pursuing fertility preservation interventions before HSCT or gene therapy 10,11 …”

Identifying at-risk populations: are we simply not doing enough fertility preservation procedures?

“…In the case series presented by Pecker et al (1), the potential pitfalls and harrowing complications of ovarian stimulation in a morbidly ill population of patients with sickle cell anemia (SCA) are presented to broaden our understanding and highlight the risks of fertility preservation procedures in this precarious population. Given the relatively infrequent occurrence of fertility preservation in this population, we appreciate the opportunity to observe secondhand the fascinating and terrifying case histories presented therein.…”

“…Pecker et al (1) point out that to qualify for HCST, severe disease complications must be manifest, which makes their elective fertility preservation treatments all that more precarious to perform. Are we failing this population by waiting too long to act?…”