In a new study, researchers evaluated ovarian reserve in female patients with sickle cell anemia (SCA) who were younger than 31 years of age and found that some of these women showed diminished ovarian reserve (DOR). The study results were presented in a report in Blood.

“In this study of complete ovarian reserve measures in women with SCA, some young women had DOR, suggesting that counseling regarding fertility preservation is indicated for this population,” the researchers wrote in their report.

Female patients who have SCA and who are younger than 30 years of age have been shown to have higher rates of DOR than seen with age-matched control females, according to the researchers. In this study, the research team had a goal of assessing ovarian reserve among women with SCA below that age threshold. They also tested hypotheses regarding whether DOR with SCA is a complication of the condition or if it is linked to hydroxyurea treatment.

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The study included female patients with SCA who were between 19 and 30 years of age, and who did not have polycystic ovarian syndrome. DOR in this study was defined as an anti-Mullerian hormone (AMH) level of ≤1.1 ng/mL + a follicle-stimulating hormone (FSH) level of >10 to 40 IU.

A total of 26 patients were included in the analysis, and they had a median age of 24 years (interquartile range, 22-28). The majority of patients (21) did not show DOR. AMH levels in patients in the study declined across age groups, which the researchers indicated was an expected decline. Patients who had DOR showed significant differences in AMH and FSH levels, compared with patients who did not have DOR (P <.01). Patients with DOR also had a median antral follicle count of 7, which the researchers explained is linked to lower oocyte yield for purposes of fertility preservation or in vitro fertilization.

The researchers found a link between DOR and hydroxyurea use. Each of the 5 patients who had DOR had received hydroxyurea, while slightly under half (10/21) of the patients without DOR were taking hydroxyurea (P =.04). The researchers did not detect differences in disease complications between groups. However, they acknowledged their findings do not exclude the possibility that SCA severity may be linked to fertility. For instance, the use of hydroxyurea could potentially serve as a proxy for SCA-associated DOR risks, they noted.

Because of the risk of DOR in some female patients with SCA, the researchers indicated that fertility preservation should be a consideration in caring for female patients with SCA. They pointed out that access to fertility preservation is not equitably distributed across patients, however. “This disparity leads to a treatment paradigm that pits hydroxyurea, a transformative SCA treatment, against fertility, instead of coordinating treatment with fertility-preserving interventions,” they wrote in their report.


Pecker LH, Hussain S, Mahesh J, Varadhan R, Christianson MS, Lanzkron S. Diminished ovarian reserve in young women with sickle cell anemia. Blood. 2022;139(7):1111-1115. doi:10.1182/blood.2021012756