Lydia H Pecker1, Jacqueline Y Maher2, Jennie Y Law3, Mary Catherine Beach4, Sophie Lanzkron5, Mindy S Christianson2. 1. Division of Pediatric Hematology, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland. Electronic address: Lpecker1@jhmi.edu. 2. Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology, School of Medicine, Johns Hopkins University, Baltimore, Maryland. 3. Marlene and Stewart Greenebaum Comprehensive Cancer Center, School of Medicine, University of Maryland, Baltimore, Maryland. 4. Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland; Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland. 5. Division of Adult Hematology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland.
Abstract
OBJECTIVE: To highlight the risk of complications among women with sickle cell anemia (SCA) receiving fertility preservation treatment (FPT) before hematopoietic stem cell transplant (HSCT). DESIGN: Single-center case series. SETTING: Academic fertility center. PATIENT(S): Women aged 15-32 years with SCA undergoing FPT before HSCT. INTERVENTION(S): Retrospective, systematic review. MAIN OUTCOME MEASURE(S): FPT modality, SCA complications during FPT. RESULT(S): 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. CONCLUSION(S): 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.
OBJECTIVE: To highlight the risk of complications among women with sickle cell anemia (SCA) receiving fertility preservation treatment (FPT) before hematopoietic stem cell transplant (HSCT). DESIGN: Single-center case series. SETTING: Academic fertility center. PATIENT(S): Women aged 15-32 years with SCA undergoing FPT before HSCT. INTERVENTION(S): Retrospective, systematic review. MAIN OUTCOME MEASURE(S): FPT modality, SCA complications during FPT. RESULT(S): 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. CONCLUSION(S): 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.
Authors: Lydia H Pecker; Sarah Hussain; Jaanvi Mahesh; Ravi Varadhan; Mindy S Christianson; Sophie Lanzkron Journal: Blood Date: 2022-02-17 Impact factor: 22.113
Authors: Robert Sheppard Nickel; Jacqueline Y Maher; Michael H Hsieh; Meghan F Davis; Matthew M Hsieh; Lydia H Pecker Journal: J Clin Med Date: 2022-04-21 Impact factor: 4.964
Authors: Sharrόn L Manuel; Molly B Moravek; Rafael Confino; Kristin N Smith; Angela K Lawson; Susan C Klock; Mary Ellen Pavone Journal: J Assist Reprod Genet Date: 2019-12-11 Impact factor: 3.412
Authors: Lydia H Pecker; Deva Sharma; Alecia Nero; Michael J Paidas; Russell E Ware; Andra H James; Kim Smith-Whitley Journal: Br J Haematol Date: 2021-07-07 Impact factor: 8.615