Hydroxyurea’s Impact on Ovarian Reserve in SCD

TOPLINE:

Hydroxyurea does not significantly reduce ovarian reserve in girls and women with sickle cell disease. Fertility preservation measures before hydroxyurea treatment may not be necessary.

METHODOLOGY:

• The study conducted in multiple French reference centers, analyzed ovarian tissue from 76 girls and young women with sickle cell disease who underwent ovarian tissue cryopreservation before hematological stem cell transplantation.
• Participants had a median age of 1src.2 years, with 65.8% being prepubertal. 46.1% had received hydroxyurea with a median daily dosage of 23.src mg/kg and median exposure time of 44 months.
• Histological examination involved counting and categorizing follicles based on their growth stage and calculating follicle densities.
• The primary outcome was to evaluate the effect of hydroxyurea on primordial follicle density, with secondary analyses on growing follicle density and the impact of vaso-occlusive crises.

TAKEAWAY:

• No significant difference in primordial follicle density was found between hydroxyurea-exposed and hydroxyurea-naive groups (P=.95).
• After adjusting for age, the density of growing follicles was marginally lower in the hydroxyurea group than in the hydroxyurea-naive group (P=.src9).
• No significant association was found between the number of vaso-occlusive crises and primordial follicle density (P=.95).
• The authors concluded that fertility preservation measures before initiating hydroxyurea treatment do not seem necessary.

IN PRACTICE:

“Overall, these findings indicate that ovarian reserve in sickle cell disease was not reduced by hydroxyurea treatment, transfusion, or vaso-occlusive crisis. Therefore, ovarian tissue cryopreservation should be considered as a fertility preservation option before gonadotoxic treatment.”

SOURCE:

The study was led by Tamara Diesch-Furlanetto, University of Basel Children’s Hospital in Basel, Switzerland. It was published online in Blood Advances.

LIMITATIONS:

One limitation of the study is the absence of anti-Mullerian hormone level measurements at the time of ovarian tissue cryopreservation, which impedes correlation with follicle density. Additionally, the long hydroxyurea wash-out period, especially in those with cerebral vasculopathy, makes it challenging to draw conclusions about the impact on growing follicles. The study also lacked a healthy control group for comparison, making it premature to conclude that follicle density in sickle cell disease patients is normal.

DISCLOSURES:

No relevant conflicts of interest were disclosed by the authors. The study was supported by grants from the foundation Stiftung für krebskranke Kinder, Regio Basiliensis, Basel, Switzerland, and SNF scientific exchange, Bern, Switzerland. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.