Fertility after Curative Therapy for Sickle Cell Disease: A Comprehensive Review to Guide Care

Robert Sheppard Nickel^{1

2

3}, Jacqueline Y Maher^{4

5}, Michael H Hsieh^{3

6}, Meghan F Davis⁷, Matthew M Hsieh⁸, Lydia H Pecker⁹

Affiliations

¹ Children's National Hospital, Division of Hematology, Washington, DC 20001, USA.
² Children's National Hospital, Division of Blood and Marrow Transplantation, Washington, DC 20001, USA.
³ School of Medicine and Health Sciences, The George Washington University, Washington, DC 20001, USA.
⁴ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Pediatric and Adolescent Gynecology, National Institutes of Health, Bethesda, MD 20810, USA.
⁵ Children's National Hospital, Pediatric and Adolescent Gynecology Program, Washington, DC 20001, USA.
⁶ Children's National Hospital, Division of Urology, Washington, DC 20001, USA.
⁷ Department of Urology, MedStar Georgetown University Hospital, Washington, DC 20001, USA.
⁸ Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20810, USA.
⁹ Division of Hematology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 20810, USA.

PMID: 35566443
PMCID: PMC9105328
DOI: 10.3390/jcm11092318

Review

Fertility after Curative Therapy for Sickle Cell Disease: A Comprehensive Review to Guide Care

Robert Sheppard Nickel et al. J Clin Med. 2022.

. 2022 Apr 21;11(9):2318.

doi: 10.3390/jcm11092318.

Authors

Robert Sheppard Nickel^{1

2

3}, Jacqueline Y Maher^{4

5}, Michael H Hsieh^{3

6}, Meghan F Davis⁷, Matthew M Hsieh⁸, Lydia H Pecker⁹

Affiliations

¹ Children's National Hospital, Division of Hematology, Washington, DC 20001, USA.
² Children's National Hospital, Division of Blood and Marrow Transplantation, Washington, DC 20001, USA.
³ School of Medicine and Health Sciences, The George Washington University, Washington, DC 20001, USA.
⁴ Eunice Kennedy Shriver National Institute of Child Health and Human Development, Pediatric and Adolescent Gynecology, National Institutes of Health, Bethesda, MD 20810, USA.
⁵ Children's National Hospital, Pediatric and Adolescent Gynecology Program, Washington, DC 20001, USA.
⁶ Children's National Hospital, Division of Urology, Washington, DC 20001, USA.
⁷ Department of Urology, MedStar Georgetown University Hospital, Washington, DC 20001, USA.
⁸ Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20810, USA.
⁹ Division of Hematology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 20810, USA.

PMID: 35566443
PMCID: PMC9105328
DOI: 10.3390/jcm11092318

Abstract

Curative therapy for sickle cell disease (SCD) currently requires gonadotoxic conditioning that can impair future fertility. Fertility outcomes after curative therapy are likely affected by pre-transplant ovarian reserve or semen analysis parameters that may already be abnormal from SCD-related damage or hydroxyurea treatment. Outcomes are also likely affected by the conditioning regimen. Conditioning with myeloablative busulfan and cyclophosphamide causes serious gonadotoxicity particularly among post-pubertal females. Reduced-intensity and non-myeloablative conditioning may be acutely less gonadotoxic, but more short and long-term fertility outcome data after these approaches is needed. Fertility preservation including oocyte/embryo, ovarian tissue, sperm, and experimental testicular tissue cryopreservation should be offered to patients with SCD pursing curative therapy. Regardless of HSCT outcome, longitudinal post-HSCT fertility care is required.

Keywords: bone marrow transplant; fertility; infertility; sickle cell disease.

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Conflict of interest statement

The authors declare no conflict of interest.

References

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Fertility after Curative Therapy for Sickle Cell Disease: A Comprehensive Review to Guide Care

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Fertility after Curative Therapy for Sickle Cell Disease: A Comprehensive Review to Guide Care

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Conflict of interest statement

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