P-361 Preserving fertility prior to hematopoietic stem cell transplant in post-pubertal women with sickle cell anaemia
Authors: Melka L , Rahal I , Barraud Lange V , Patrat C , Chapron C , Santulli P , Joseph L , Bourdon M 
Published: July 2024

Abstract

Study question
Can fertility preservation (FP) in women with sickle cell anemia (SCA) be linked to an increased risk of hematopoietic complications?

Summary answer
Only one participant on sixteen in our series had to discontinue the ovarian stimulation due to a complication related to a painful vaso-occlusive crisis (VOC).

What is known already
SCA is one of the most common severe monogenic diseases worldwide. It is a multisystemic disorder characterized by anaemia, increased haemolysis, and VOC. Despite advances in management, patients remain at a high risk of significant morbidity, especially increased thromboembolic events and early death. With the introduction of hematopoietic stem cell transplantation(HSCT) for non-malignant conditions, there is now a curative treatment for this debilitating condition. The myeloablative regimens for HSCT may impact ovarian reserve; therefore consideration of FP could be recommended. There is limited data on FP in this context and the risk of hematopoietic complications such as VOC is unclear.

Study design, size, duration
Cohort of women with SCA consulting at our center for FP before a HSCT project between 2016 and 2023. FP modalities were oocytes vitrification after ovarian stimulation and ovarian tissue cryopreservation (partial unilateral ovariectomy under laparoscopy). A protocol for the prevention of the risk of VOC, including hydration, oxygen therapy, and warming ± transfusion exchanges and for thromboembolic events was initiated before and during FP treatment, tailored on a case-by-case basis with the referring haematologist.

Participants/materials, setting, methods
The data related to hematopoietic complications (including VOC and thromboembolic event) [ps1] during FP were collected. Additionally, data on the follow-up of SCA, including received and planned treatments post-FP, were collected. This encompassed information on the completed FP treatments, preventive measures for SCA complications, and the outcomes of FP. Descriptive analysis was conducted.

Main results and the role of chance
During the study period, sixteen women affected with SCA aged 15–37 years have consulted for FP in our center. The mean age and BMI were 28.43±6.66 years and 21.97 ±3.46 respectively. The mean AMH level and antral follicle count were 1.77±1.70 and 15.83 ±7.12 respectively. Twelve patients underwent oocytes vitrification after mulfifollicular ovarian stimulation (OS), two had ovarian tissue cryopreservation, and 1 underwent both technics. One patient, initially planning for OS, cancelled after counselling. Among the 13 women that received an OS, 18 cycles were performed in total. The mean number of OS cycles per patient was 1.38±0.73. Protocols were antagonist (n = 16) or short agonist protocols (n = 2). The mean duration of gonadotropin treatment was 9.91±1.84 days, and the mean total gonadotropin dose was 3187.5±711.8 IU. Five OS were cancelled before oocyte retrieval because of an insufficient ovarian response. The mean number of oocytes retrieved was 8.83±5.61 per cycle. The mean number of cryopreserved oocytes was 12.00±5.66. One patient had to discontinue the OS due to a complication related to a painful VOC at 3 days of stimulation. As recommended, the hydroxycarbamide treatment was temporarily suspended to perform the FP. For patients who underwent unilateral partial ovariectomy, no complications were reported.

Limitations, reasons for caution
The main limitation is that this study is a small, retrospective case series; however, this represents the largest series to date.

Wider implications of the findings
Although limited, current data suggest that FP with specific conditioning does not pose a significant risk of complications in patients with SCA who are to undergo gonadotoxic treatment for HSCT.

Trial registration number
NA