Risk of infertility among women with sickle cell disease

To assess whether women with sickle cell disease (SCD) are more likely to report infertility than comparison women.

Retrospective cohort study.

Women aged 20 to 45 years with SCD recruited from a sickle cell clinic in Atlanta, Georgia (n = 129), and a comparison group of Black women aged 20 to 45 living in Atlanta (n = 236).

We compared women with SCD to the comparison women. For women with SCD, we also examined hydroxyurea use and chronic transfusion therapy based on medical records.

Infertility measures were derived from interview questions. We defined unprotected-intercourse infertility as ≥12 months of unprotected intercourse without pregnancy, and attempting-pregnancy infertility as ≥12 months of attempting pregnancy.

Women with SCD were more likely to report unprotected-intercourse infertility than comparison women (adjusted hazard ratio [aHR]: 1.4, 95% confidence interval [CI]: 0.9-2.2), but this difference was attenuated for attempting-pregnancy infertility (aHR: 1.2, 95% CI 0.4-2.5). Among women with SCD, those treated with hydroxyurea were more likely to report unprotected-intercourse infertility (aHR: 1.4, 95% CI: 0.8-2.7). Over a quarter of women with SCD were not satisfied with the information they received about how SCD and its treatments could affect their ability to get pregnant, and most had not talked to a healthcare provider about this topic.

Given the limited sample size of our study, our results should be interpreted with caution, but they suggest that women with SCD who desire children in the future might benefit from fertility counseling.