Data Show Higher Infertility and Lower Treatment in SCD Population

Eleanor Stevenson, PhD

Credit: Duke University

Infertility is a widespread reproductive health issue affecting a significant proportion of the global population, and a new study provided evidence to support the increased risk of developing infertility observed among individuals living with sickle cell disease (SCD). This risk is due to various factors such as chronic anemia, oxidative stress, and decreased blood flow to reproductive organs.¹

The study investigators aimed to describe the prevalence of infertility and infertility treatment seeking among individuals enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry, and also identify sociodemographic and clinical correlates of infertility. Despite this population’s susceptibility, there are limited data, especially on the understanding of those who search for treatment.

Results showed 16.9% of males and 23.7% of females reported infertility, which is higher than the rates reported in the general population (12% of males; 11% of females). However, only 22.8% of this subgroup had sought a fertility consultation, indicating that fertility care treatment seeking is less frequent among individuals with SCD compared with the general public.

Investigating the Prevalence of Infertility and Fertility Treatment

Eleanor Stevenson, PhD, Duke University School of Nursing, and a group of investigators conducted a cross-sectional analysis. The study population included 2108 women and men aged 18 years and above that enrolled in the SCDIC registry and completed the fertility questionnaire. The SCDIC is a network of clinics and researchers that aims to improve care and outcomes for individuals living with SCD in the US.

The questionnaire included infertility-specific questions such as whether they had ever tried to conceive for a year or longer without success, whether they had sought fertility consultation, and whether they had received specific infertility treatments.

Of those who sought fertility consultation, 41% received infertility testing, and 58% received advice, but only a few received specific treatments such as ovulation medication (19.1%), fallopian tubal surgery (4.8%), other female treatments (17.5%), varicocelectomy (8.1%), or other male treatments (10.8%).

These findings suggested there’s a gap in the provision of infertility treatments for individuals with SCD who seek fertility care.

Investigators also identified sociodemographic and clinical correlates of infertility. According to the analysis, Increasing age, employment status, and interaction between gender and single marital status were associated with reported infertility.

However, no differences were observed between groups relative to SCD genotype, self-reported hydroxyurea use at any time during life, type of medical insurance, income, or education.

These data provided further understanding of the prevalence of infertility and infertility treatment seeking among individuals with SCD. While results demonstrated a higher rate of infertility in this population, they also indicated these individuals seek fertility care treatment less frequently compared with the general population.

“To our knowledge, this is the first study to examine self-reported identification of and treatment for infertility among a large sample of people with SCD. These findings suggest that (a) infertility occurs at a higher rate, but fertility care treatment seeking is less frequent than in the general public; and (b) sociodemographic and clinical differences between individuals who report experiencing infertility and those who do not did not emerge in this study,” investigators wrote.

They acknowledged the need for improved provision of infertility treatments for individuals with SCD who seek fertility care. Additionally, these new findings included important sociodemographic and clinical information which can help in the development of targeted interventions to address this issue.

References:

1. Stevenson E, Tanabe P, Knisely M, et al. Infertility and treatment-seeking practices among females and males with sickle cell disease in the Sickle Cell Disease Implementation Consortium registry [published online ahead of print, 2023 Apr 14]. Pediatr Blood Cancer. 2023;e30356. doi:10.1002/pbc.30356