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Review
. 2024 Aug;17(8):493-504.
doi: 10.1080/17474086.2024.2372320. Epub 2024 Jun 26.

Sickle cell disease and infertility risks: implications for counseling and care of affected girls and women

Lydia H Pecker  1   2 , Katie Cameron  2   3
Affiliations
Review

Sickle cell disease and infertility risks: implications for counseling and care of affected girls and women

Lydia H Pecker et al. Expert Rev Hematol. 2024 Aug.

Abstract

Introduction: Sickle cell disease (SCD), its treatments and cures present infertility risks. Fertility counseling is broadly indicated for affected girls and women and fertility preservation may appeal to some. Several streams of evidence suggest that the reproductive lifespan of women with SCD is reduced. Pregnancy is associated with high miscarriage rates. There are enduring questions about the effects of highly effective hydroxyurea treatment on female fertility. Current conditioning regimens for gene therapy or hematopoietic stem cell transplant are gonadotoxic. Fertility preservation methods exist as non-experimental standards of care for girls and women. Clinicians are challenged to overcome multifactorial barriers to incorporate fertility counseling and fertility preservation care into routine SCD care.

Areas covered: Here we provide a narrative review of existing evidence regarding fertility and infertility risks in girls and women with SCD and consider counseling implications of existing evidence.

Expert opinion: Addressing fertility for girls and women with SCD requires engaging concerns that emerge across the lifespan, acknowledging uncertainty and identifying barriers to care, some of which may be insurmountable without public policy changes. The contemporary SCD care paradigm can offer transformative SCD treatments alongside comprehensive counselling that addresses fertility risks and fertility preservation opportunities.

Keywords: Sickle cell disease; curative therapies; fertility; infertility; patient counseling; pregnancy.

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Figures

Figure 1.
Figure 1.
Antimullerian hormone in women with hemoglobin SS disease who participated in the Multi-Center Study of Hydroxyurea Adapted from Pecker et al, Hydroxycarbamide exposure and ovarian reserve in women with sickle cell disease in the Multicenter Study of Hydroxycarbamide, Brit J Haematol
Figure 2.
Figure 2.
Proposed algorithm for reproductive endocrinologists managing ovarian stimulation and retrieval in girls and women with sickle cell disease (SCD). Adapted from Pecker et al, Risks associated with fertility preservation for women with sickle cell anemia, Fertil Steril
See this image and copyright information in PMC

References

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