Hydroxyurea, a long-utilized medication for sickle cell disease, has been scrutinized over concerns about its potential impact on female fertility. However, recent research suggests that these concerns may be misplaced. A new study indicates that hydroxyurea does not affect ovarian reserve, which refers to the number of viable eggs a woman has available for conception.
The research, led by Dr. Tamara Diesch-Furlanetto from the University Children’s Hospital Basel in Switzerland, provides reassurance to women with sickle cell disease. “Women should feel more confident about using hydroxyurea as a treatment option,” Dr. Diesch-Furlanetto stated in a release from the American Society of Hematology (ASH). She emphasized that while hydroxyurea effectively reduces sickle cell-related crises and hospitalizations, it appears not to impair fertility.
Sickle cell disease, affecting over 100,000 individuals in the United States, causes red blood cells to assume a sickle shape, leading to painful blockages in blood vessels. This condition is especially prevalent among Black Americans, impacting one in 365 births, and Hispanic Americans, affecting one in 16,300 births.
Since the 1960s, hydroxyurea has been a cornerstone in managing sickle cell disease, reducing the incidence of vaso-occlusive crises (VOCs) and the need for blood transfusions. Despite its benefits, concerns persisted about its effect on female fertility, as women on the drug often showed lower levels of hormones associated with ovarian function.
To address these concerns, Diesch-Furlanetto and her team analyzed ovarian tissue from 76 female sickle cell patients who had undergone cryopreservation (egg freezing) before receiving stem cell transplants. Of these patients, 35 had been treated with hydroxyurea, while the remaining 41 were prepubescent at the time of tissue collection.
The study found no significant differences in the density of primordial follicles, which are indicative of ovarian reserve, between those treated with hydroxyurea and those who were not. “This study is the first to conclusively show through histological examination that hydroxyurea does not impact ovarian reserve,” Diesch-Furlanetto said.
The findings are consistent with the experiences of many women with sickle cell disease who have successfully conceived after hydroxyurea treatment. Dr. Diesch-Furlanetto advises that while ovarian tissue preservation is a prudent consideration before stem cell therapy, it may not be necessary solely due to hydroxyurea treatment.
Financial implications may also arise from these findings. Concerns over fertility have led some women to opt for egg freezing, a procedure that is not universally covered by insurance. As of early 2023, only 11 states mandate private insurance coverage for fertility preservation, with just two states providing public insurance coverage.
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