Hydroxycarbamide exposure and ovarian reserve in women with sickle cell disease in the Multicenter Study of Hydroxycarbamide.

Pubmed ID: 32712966

Pubmed Central ID: PMC10189607

Journal: British journal of haematology

Publication Date: Dec. 1, 2020

Affiliation: Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

MeSH Terms: Humans, Adult, Female, Middle Aged, Anemia, Sickle Cell, Hydroxyurea, Hemoglobin, Sickle, Anti-Mullerian Hormone, Ovarian Reserve

Grants: R21 HL144973

Authors: Lanzkron S, Pecker LH, Hussain S, Christianson MS

Cite As: Pecker LH, Hussain S, Christianson MS, Lanzkron S. Hydroxycarbamide exposure and ovarian reserve in women with sickle cell disease in the Multicenter Study of Hydroxycarbamide. Br J Haematol 2020 Dec;191(5):880-887. Epub 2020 Jul 26.

Studies:

Abstract

The application of modern ovarian reserve measures to women with sickle cell disease (SCD) may help answer longstanding questions about whether SCD or hydroxycarbamide (HC; also known as hydroxyurea) affect women's reproductive lifespan. Anti-Müllerian hormone (AMH), an established marker of ovarian reserve, is used to assess the ovarian follicle pool. We used a standard clinical assay to measure AMH in 285 banked samples from 93 female subjects with haemoglobin SS from the historic Multicenter Study of Hydroxyurea (MSH), which led to the United States Food and Drug Administration approval of HC for adults with SCD. No samples from the randomised portion of the MSH remain, so samples from the decade-long MSH follow-up studies were analysed. Most subjects were exposed to HC (86/93). The median AMH levels were lower in study subjects than in age- and sex-matched reference values. The median AMH levels consistent with diminished ovarian reserve, a risk factor for infertility, occurred in subjects starting at the age of 25-30 years; in healthy women, this occurs after the age of 40 years. In multivariate analysis, taking HC was independently associated with a low AMH (β = 0·001, 95% confidence interval -0·002 to 0·000; P = 0·006). These results suggest that ovarian reserve is prematurely reduced in women with haemoglobin SS and raise the possibility that HC contributes to this finding.