Is Fertility Preservation Safe for Women with Sickle Cell Disease?

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Although peripheral blood stem cell transplant (PBSCT) can cure sickle cell disease, the treatment runs the risk of permanent infertility.

Although peripheral blood stem cell transplant (PBSCT) can cure sickle cell disease, the treatment runs the risk of permanent infertility.

Researchers examined the outcomes of women with sickle cell disease undergoing fertility preservation who were set to get PBSCT. Would the procedure be successful? Would it be safe? In a poster session at the 57th American Society of Hematology Annual Meeting (ASH 2015) in Orlando, Florida, Torie Plowden, MD, MPH, from the National Institutes of Health’s (NIH) National Institute of Child Health and Human Development, will detail the findings.

Nine women were screened for the study but the final cohort consisted of four women of reproductive ages. They all underwent controlled ovarian hyperstimulation (COH), started or continued on prophylactic anticoagulation, and maintained on hydroxyurea.

“The safest stimulation protocol (i.e. antagonist cycle with leuprolide trigger for final oocyte maturation) was successful in all patients despite multiple risk factors for failed leuprolide trigger,” the authors explained.

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The women (ages 20, 34, 24, and 27) also had transvaginal oocyte retrieval and cryopreservation of mature eggs which resulted in 8, 13, 15, and 21 oocytes, respectively.

There were no venous thrombotic events, however, patients one and two reported headaches after gonadotropin injections. Patients three and four had acute exacerbation of their chronic pain during the procedure, but it was managed with pain medication and IV fluids. The team noted that the third patient went through two cycles because of low mature oocyte yield from the initial cycle. Although the four patients had side effects, they were manageable even though they had severe sickle cell disease and co-morbid conditions.

The findings indicate that the procedure is in fact safe for women with sickle cell disease.

“Fertility preservation is important not only before PBSCT to cure their underlying disease, but also because of high rates of premature ovarian insufficiency in the sickle cell disease population post-transplant,” the authors concluded.

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