Diminished ovarian reserve in women with transfusion-dependent beta-thalassemia major: Is iron gonadotoxic?

Uysal, Aysel; Alkan, Gül; Kurtoğlu, Ayşegül Uğur; Erol, Onur; Kurtoğlu, Erdal

doi:10.1016/j.ejogrb.2017.06.038

Cited by 20 publications

(10 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies on ovarian function and TM mainly focused on ovarian reserve and generally supported an impairment: AMH and AFC are consistently lower [4,[7], [8], [9], [10], [11]]. Our data is in agreement with these findings since both biomarkers resulted reduced in exposed women.…”

Section: Discussionsupporting

confidence: 92%

“…Recent studies also revealed that patients with TM have lower levels of anti-Mullerian hormone (AMH) and reduced antral follicular count (AFC), suggesting that the peripheral excess of iron may also be toxic locally to the gonads, harming the ovarian reserve [4,[7], [8], [9], [10], [11]]. In addition, iron excess, in particular non-transferrin-bound iron and its redox active form, may actually impact on oocyte quality.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Mensi

Borroni

Reschini

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

Background Women with thalassaemia major typically experience hypogonadotropic hypogonadism because of the toxic effects of iron overload on the anterior pituitary. Moreover, in affected women, serum anti-Mullerian hormone (AMH) and antral follicle count (AFC) are also shown to be reduced, suggesting that the peripheral excess of iron could also harm the ovarian reserve. To date, the detrimental effects of the disease on oocyte quality have not been investigated. Materials and methods Women with thalassaemia major who underwent in vitro fertilization (IVF) cycles were retrospectively identified over a 9 years period. They were matched (with a 1:5 ratio) by study period and age to a control group of infertile women undergoing IVF. Embriological variables were compared between the two groups. The primary outcome was the rate of top quality embryos. Results Twenty-one women with thalassaemia major (exposed group) and 105 controls (unexposed group) were ultimately included. Serum AMH was 0.6 [0.2–1.8] and 1.5 [0.7–3.5] ng/ml, respectively (p = 0.05). AFC was 4 (1–7.5) and 11 (5.5–16), respectively (p < 0.001). The total dose of gonadotropins used was higher in exposed women but the number of retrieved oocytes and oocytes used did not differ. The fertilization rate was higher in exposed compared to unexposed women, being 100% (76–100%) and 75% (50–100%). respectively (p = 0.03). The cleavage rate was also higher, being 75% (39–100%) and 50% (29–64%), respectively (p = 0.04). In contrast, the rate of top quality embryos did not differ, being 20% (0–76%) and 25% (5–50%), respectively (p = 0.98). Conclusions Despite lower ovarian reserve, oocyte quality is not significantly affected in women with thalassaemia major.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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

Mensi

Borroni

Reschini

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

show abstract

“…Another study also demonstrated that AMH level and antral follicle count are signi cantly decreased in women with transfusion-dependent thalassemia major compared with agematched controls. 12 These ndings support a deleterious effect of iron overload on ovarian tissue, which may result in an increase in reactive oxygen species and the subsequent acceleration in follicular aging. 14 An earlier study has found high redox activity in the ovarian follicular uid from a woman with thalassemia major, which suggested that redox-active iron ions may mediate free radical production and induce ovarian tissue injury.…”

Section: Discussionmentioning

confidence: 74%

Premature Ovarian Insufficiency After Bone Marrow Transplantation for Thalassemia Major in a Patient With Primary Amenorrhea and 46, XY Karyotype: a Case Report and Literature Review

H¹,

Li²,

X³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Iatrogenic factor is one of the recognized causes for premature ovarian insufficiency. The aim of this case report was to present a rare case with premature ovarian insufficiency and 46, XY karyotype after bone marrow transplant for thalassaemia major at childhood. We also reviewed some relevant literature in this report.Case presentation: A 17-year-old girl was presented with primary amenorrhea and premature ovarian insufficiency after receiving chemotherapy and bone marrow therapy from her brother due to thalassaemia major at childhood. She had poor secondary sex characteristics, assessed as stage I for the development of breasts and external genitalia based on the Tanner scale. Transabdominal ultrasound showed small uterus with visible endometrial lining and small ovaries. Laboratory data showed hypergonadotropic hypogonadism profile with low level of estrogen and high level of follicular-stimulating hormone (FSH). Patient’s peripheral lymphocytes karyotype was 46, XY. Conclusions: A correct diagnosis is not only dependent on clinical manifestations, but also the detailed medical history. In light of the relatively high prevalence of thalassemia, fertility preservation should be considered for young girls before they receive chemotherapy, radiation treatment and bone marrow transplant.

show abstract

“…After repeated red blood cell transfusions, patients with thalassemia major may have ovarian impairment due to iron overload, when the transferrin-dependent system is inhibited through ferritin saturation pathway and excessive iron accumulation occurs through the non-transferrin bound iron (NTBI) pathway ( 11 ). Although the most common endocrinopathy in patients with thalassemia is the hypogonadism resulting from iron deposition in the hypothalamic and/or pituitary cells ( 12 ), it is also worth noting that iron overload may affect ovarian function directly as well. An earlier study has shown an inverse correlation between AMH level and NTBI ( 13 ), suggesting suspected ovarian tissue iron overload in women with thalassemia major.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Is It Premature Ovarian Insufficiency or Swyer Syndrome After Bone Marrow Transplantation?

et al. 2022

Front. Pediatr.

View full text Add to dashboard Cite

Introduction: Iatrogenic factor is one of the recognized causes for premature ovarian insufficiency. The aim of this case report was to present a rare case with premature ovarian insufficiency and 46, XY karyotype after bone marrow transplant (BMT) for thalassaemia major at childhood. We also reviewed some relevant literature in this report.Case Presentation: A 17-year-old girl was presented with primary amenorrhea and premature ovarian insufficiency after receiving chemotherapy and BMT from her brother due to thalassaemia major at childhood. She had poor secondary sex characteristics, assessed as stage I for the development of breasts and external genitalia based on the Tanner scale. Transabdominal ultrasound showed small uterus with visible endometrial lining and small ovaries. Laboratory data showed hypergonadotropic hypogonadism profile with low level of estrogen and high level of follicular-stimulating hormone (FSH). Patient's peripheral lymphocytes karyotype was 46, XY.Conclusions: This case was diagnosed as a chemotherapy induced premature ovarian insufficiency. Patient's peripheral lymphocytes karyotype (46, XY) after she received BMT from a male donor was a misleading finding, and the case could be easily misdiagnosed as Swyer syndrome. A correct diagnosis in such cases should depend not only on the recent clinical findings, but also on the detailed medical history. To prevent premature ovarian insufficiency in similar cases, fertility preservation should be offered to girls before they receive chemotherapy, total body irradiation and BMT.

show abstract

Diminished ovarian reserve in women with transfusion-dependent beta-thalassemia major: Is iron gonadotoxic?

Cited by 20 publications

References 20 publications

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

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

Premature Ovarian Insufficiency After Bone Marrow Transplantation for Thalassemia Major in a Patient With Primary Amenorrhea and 46, XY Karyotype: a Case Report and Literature Review

Case Report: Is It Premature Ovarian Insufficiency or Swyer Syndrome After Bone Marrow Transplantation?

Contact Info

Product

Resources

About