Sickle cell disease affects ovarian reserve

  • Kopeika J & al.
  • PLoS One
  • 1 Jan 2019

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Ovarian reserve, measured by anti-Müllerian hormone (AMH), is reduced in women with sickle cell disease (SCD).

Why this matters

  • SCD is characterized by chronic hemolytic anemia, intermittent vaso-occlusive pain crises, and risk for multiorgan dysfunction.
  • 300,000 children are born with SCD each year.
  • AMH is a biomarker for ovarian reserve.
  • Preconception counseling for women with SCD should discuss risk of decreased fertility at age >30 years.

Key results

  • AMH levels were lower in patients with SCD compared with controls (7.6 vs 13.4 pmol/L; P=.01).
  • AMH decreased with age in all women, but the decrease occurred at an earlier age in women with SCD.
  • This decrease became more significant after age 30 years.
  • In women ages 36-40 years, 55% of controls had low or negligible AMH compared with 90% of the SCD group (P=.043).

Study design

  • Case-controlled cohort observational study.
  • Women attending a hematology clinic with the diagnosis of stable SCD were identified (n=50) and compared with a control group consisting of women attending a reproductive medicine clinic (n=73); patients were further matched by age and ethnicity.
  • AMH levels were drawn as a routine part of care and assessment.
  • Funding: None.

Limitations

  • Small, heterogeneous cohort.

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