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

Document Type

Journal Article

Publication Date

4-21-2022

Journal

Journal of clinical medicine

Volume

11

Issue

9

DOI

10.3390/jcm11092318

Keywords

bone marrow transplant; fertility; infertility; sickle cell disease

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.

Department

Urology

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