Risks associated with fertility preservation for women with sickle cell anemia

Hematopoietic stem cell transplant, which cures sickle cell anemia, requires exposure to gonadotoxic therapies; addressing the disease-specific risks for fertility preservation treatment is important for these patients.

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Volume 110, Issue 4, Pages 720–731

Authors:

Lydia H. Pecker, M.D., Jacqueline Y. Maher, M.D., Jennie Y. Law, M.D., Mary Catherine Beach, M.D., M.P.H., Sophie Lanzkron, M.D., M.H.S., Mindy S. Christianson, M.D.

Abstract:

Objective

To highlight the risk of complications among women with sickle cell anemia (SCA) receiving fertility preservation treatment (FPT) before hematopoietic stem cell transplant (HSCT).

Design

Single-center case series.

Setting

Academic fertility center.

Patient(s)

Women aged 15–32 years with SCA undergoing FPT before HSCT.

Intervention(s)

Retrospective, systematic review.

Main Outcome Measure(s)

FPT modality, SCA complications during FPT.

Result(s)

Over an 8-year period (2009–2017), seven women with SCA ages 15–32 years (mean 28.5 years) underwent FPT with embryo cryopreservation (n = 1), oocyte cryopreservation (n = 4), and ovarian tissue cryopreservation (n = 2). The five women subjects who underwent oocyte or embryo cryopreservation were treated with an antagonist controlled ovarian hyperstimulation protocol and individualized gonadotropin dosing. The trigger medications included leuprolide acetate (n = 2), and human chorionic gonadotropin (n = 3). Most patients (n = 5) received a disease-modifying therapy for SCA (hydroxyurea or chronic transfusions) before FPT. Three patients experienced periprocedural SCA complications that included life-threatening respiratory failure, painful crisis requiring interruption of a stimulation cycle, and severe postharvest painful crisis.

Conclusion(s)

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.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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