Risks associated with fertility preservation for women with sickle cell anemia - Fertility and Sterility

To highlight the risk of complications among women with sickle cell anemia (SCA) receiving fertility preservation treatment (FPT) before hematopoietic stem cell transplant (HSCT). Single-center case series. Academic fertility center. Women aged 15–32 years with SCA undergoing FPT before HSCT. Retrospective, systematic review. FPT modality, SCA complications during FPT. 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. 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. Riesgos asociados a la preservación de fertilidad en mujeres con anemia de células falciformes. Subrayar el riesgo de complicaciones entre las mujeres con anemia de células falciformes (SCA) que realizan preservación de fertilidad (FPT) antes de someterse a un transplante de células madre hematopoyéticas (HSCT). Serie de casos de un centro único. Centro de fertilidad universitario. Mujeres de edades comprendidas entre 15 y 32 a？os con SCA sometidas a FPT antes de HSCT. Revisión sistemática retrospectiva. Modalidad de FPT, complicaciones de la SCA durante la FPT. En un periodo de 8 a？os (2009-2017), siete mujeres con SCA de edades comprendidas entre 15 y 32 a？os (media 28,5 a？os) realizaron FPT con criopreservación de embriones (n=1), criopreservación de ovocitos (n=4) y criopreservación de tejido ovárico (n=2). Las cinco mujeres que realizaron criopreservación de ovocitos o embriones siguieron un protocolo de hiperestimulación ovárica controlada con antagonistas y dosis individualizadas de gonadotrofinas. La maduración ovárica se indujo con acetato de leuprolide (n=2) y gonadotrofina coriónica humana (n=3). La mayoría