Oocyte quality in women with thalassaemia major: insights from IVF cycles

Thalassemia and assisted reproduction: non-transfusion-dependent thalassemia shows no significant effect on live birth rates after embryo transfer

Background

Thalassemia is a hereditary blood disorder that can impact fertility due to various factors such as iron overload and endocrine disruption. While the effects of iron overload on fertility outcomes in transfusion-dependent thalassemia (TDT) have been well-documented, there is limited data on how NTDT affects assisted reproductive technology (ART) outcomes. This study aims to assess the fertility and pregnancy outcomes of NTDT patients compared to thalassemia carriers (TC) patients in IVF and frozen embryo transfer (FET) cycles.

Methods

This retrospective cohort study analyzed 6,911 female patients who underwent autologous IVF treatment at a private reproductive center between January 2013 and December 2022. The study included women who were carriers of thalassemia or diagnosed with NTDT. ART outcomes, including oocyte retrieval rate, embryo development (maturation rate, number of fertilized oocytes and blastocyst formation rate), clinical pregnancy rate, live birth rate, and miscarriage rate, were compared between NTDT and TC patients. Propensity score matching (PSM) and multivariable adjustments for potential confounders were applied in the statistical analyses.

Results

NTDT patients had a significantly lower oocyte retrieval rate (0.88 vs. 0.93, p < 0.05) and a longer interval from medication initiation to oocyte retrieval (13.35 days vs. 12.38 days, p < 0.05) compared to TC patients. However, NTDT patients exhibited higher oocyte maturation rates and a greater number of fertilized oocytes. Despite these differences in embryo development metrics, there were no statistically significant differences in clinical pregnancy rates and live birth rates between NTDT and TC patients in both fresh embryo transfer (IVF-ET) and FET cycles (p > 0.05). These findings suggest that while NTDT may affect certain aspects of embryo development, it does not significantly impact overall pregnancy outcomes in ART.

Conclusion

This study provides valuable insights into ART outcomes for NTDT patients, showing that, despite challenges in oocyte retrieval, their fertility and pregnancy outcomes are comparable to those of thalassemia carriers. Clinicians should consider individualized treatment plans and provide comprehensive counseling for NTDT patients, focusing on their specific fertility characteristics, to optimize ART outcomes. Further research is needed to explore the underlying mechanisms affecting embryo development in NTDT patients and to confirm these findings in broader populations.

Pregnancy and assisted reproductive technology use in Australian female transfusion-dependent haemoglobinopathy patients: a 20-year retrospective analysis

BACKGROUND

In the last few decades, the life expectancy of patients with transfusion-dependent thalassaemia (TDT) and sickle cell disease (SCD) has improved significantly, in part because of improved iron chelation. Fertility challenges and pregnancy complications have historically limited reproductive options in this group; however, improved multi-disciplinary care has made infertility a chronic disease complication requiring attention. Despite this, there are very few reports and no Australian data describing fertility and pregnancy outcomes in this population.

AIMS

To identify the rate of assisted reproductive technologies (ART) utilisation in our female transfusion-dependent haemoglobinopathy patients and to establish the nature of maternal and neonatal complications in this cohort.

METHODS

A 20-year retrospective analysis (1997-2017) at an Australian centre captured data on conception rates, use of assisted reproductive techniques (ART), and pregnancy and neonatal outcomes in female transfusion-dependent haemoglobinopathy patients.

RESULTS

Conception was attempted in 14 women (11 TDT and three SCD) during the study period. A total of 28 pregnancies resulting in 25 live births were recorded. ART supported 13 conceptions. A positive association was not identified between elevated mean serum ferritin and ART use; however, all patients with an established diagnosis of hypogonadotropic hypogonadism (HH) required ART. Maternal complications included gestational diabetes mellitus and post-partum haemorrhage. There were no cardiac complications. Two-thirds of women underwent lower segment caesarean section, with prematurity complicating 20% of births. There were no neonatal or maternal deaths.

CONCLUSION

Pregnancy is an achievable goal for women with transfusion-dependent haemoglobinopathies, although the support of ART may be required in a subset of patients.

Prevalence of hypogonadism in transfusion-dependent β-thalassemia patients of Bangladesh: investigating the role of serum ferritin level as a diagnostic tool

INTRODUCTION

Hypogonadism is one of the most frequent complications in transfusion-dependent thalassemia patients and early recognition and treatment is the core element in restoring impaired gonadal function. Despite the high burden of disease, relevant studies are scarcely addressing the gonadal function of such patients in Bangladesh. The pattern of gonadal function in transfusion-dependent thalassemia patients must be characterized before planning a generalized management plan. Moreover, since iron overload is a key reason behind hypogonadism in thalassemia patients, investigating the role of serum ferritin level as a diagnostic tool for hypongadism was also an aim of this study.

METHODS

This cross-sectional study was conducted at the Department of Transfusion Medicine of the Bangabandhu Sheikh Mujib Medical University. According to the inclusion and exclusion criteria, a total of 94 patients were enrolled in this study. A detailed history and thorough clinical examination were carried out in each patient and recorded using a pretested structured questionnaire. In addition, the laboratory assessment of serum ferritin, luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone and estradiol in serum were also performed. The data were analyzed using the STATA (v.16).

RESULTS

The mean age of the patients with transfusion-dependent thalassemia was 18.81 ± 4.65 (SD), with 53.3% of the patients being male. The overall prevalence of hypogonadism was 35.11%, 18.1% being normogonadotropic, 11.7% being hypogonadotropic and 5.3% being hypergonadotropic. The serum ferritin level was significantly higher (p < 0.001) in patients with hypogonadism (Eugonadal: 2,174.79 (± 749.12) ng/ml; Hypogonadal: 3,572.59 (± 1,199.49) ng/ml). The area under the receiver operating characteristic (ROC) curve of serum ferritin was high (0.83) and the p-value was highly significant (< 0.001).

CONCLUSION

Therefore, the serum ferritin level and gonadal hormone analysis of transfusion-dependent thalassemia patients can be considered a screening tool for assessing gonadal function and early detection and prevention of hypogonadism.

Fertility and Pregnancy in Women with Transfusion-Dependent Thalassemia

Because women with transfusion-dependent thalassemia are seeking pregnancy, ensuring the best outcomes for both mother and baby require concerted and collaborative efforts between the hematologist, obstetrician, cardiologist, hepatologist, and genetic counselor among others. Proactive counseling, early fertility evaluation, optimal management of iron overload and organ function, and application of advances in reproductive technology and prenatal screening are important in ensuring a healthy outcome. Many unanswered questions remain requiring further study, including fertility preservation, non-invasive prenatal diagnosis, chelation therapy during pregnancy, and indications and duration of anticoagulation.