Hydroxyurea Exposure Unaffects Ovarian Reserve in Sickle Cell

On Thursday, July 25, 2024, a significant study was highlighted in Blood Advances, revealing that the use of hydroxyurea in girls and young women with sickle cell disease (SCD) does not diminish their ovarian reserve. This research, led by Tamara Diesch-Furlanetto, Ph.D., from the University of Basel Children's Hospital in Switzerland, offers critical insights into the fertility preservation of patients undergoing treatment for SCD.

The research team undertook a detailed analysis of ovarian tissue from girls and young women diagnosed with SCD who had undergone ovarian tissue cryopreservation (OTC) prior to receiving hematological stem cell transplantation. The study aimed to assess the impact of hydroxyurea, a common treatment for SCD, on ovarian reserve by examining and categorizing follicles based on their developmental stages through digitized slides of the ovarian tissue.

A total of 76 SCD patients participated in the study, with a median age of 10.2 years at the time of OTC. The demographic included both prepubertal and postpubertal individuals, with 50 of the participants being prepubertal. Notably, 35 of these patients had been treated with hydroxyurea.

By calculating the densities of various follicle types, the researchers sought to understand any correlations between follicular density and patient characteristics, clinical manifestations, and treatment regimens. The results indicated that the primordial follicle density was similar between those who had been exposed to hydroxyurea and those who had not (5.8 versus 4.2 follicles/mm²). Even after adjusting for age, the density of growing follicles showed only a slight reduction in the hydroxyurea group compared to the non-hydroxyurea group.

Importantly, the study found that other clinical factors, such as the occurrence of vaso-occlusive crises (VOC), did not significantly affect follicular density. This suggests that the ovarian reserve in young SCD patients remains largely unaffected by hydroxyurea treatment, transfusions, or VOC.

The authors of the study emphasized the implications of these findings for fertility preservation in SCD patients. They recommended that OTC should be regarded as a viable option for preserving fertility before initiating gonadotoxic treatments. This is particularly relevant given the potential reproductive challenges faced by individuals with SCD due to their disease and its treatments.

In summary, this study provides reassuring evidence that hydroxyurea, a crucial treatment for managing SCD, does not compromise ovarian reserve in young female patients. These findings support the continued use of hydroxyurea without detrimental effects on reproductive health and highlight the importance of considering OTC as a fertility preservation strategy in this patient population before undergoing treatments that could potentially harm ovarian function.