Haemoglobinopathy: considerations for reproductive health

Abstract

Key content An overview is given of the different types of haemoglobinopathies and the effect of iron overload on the function of vital organs, including the endocrine system. Assessment modalities for ovarian and testicular function measurement. Current management options for patients with hypogonadotrophic hypogonadism secondary to iron overload include chelation therapy from an early age and human menopausal gonadotrophin to induce ovulation and spermatogenesis. Egg, sperm or embryo donation remain alternative options in cases refractory to stimulation protocols. Cryopreservation is an option to retain future fertility in some patients with a haemoglobinopathy, but is not standard care. We consider the psychological impact of a haemoglobinopathy and iron overload, and their effects on reproductive health, as well as good medical support by a multidisciplinary team. Learning objectives To understand the current evidence of the impact of iron overload secondary to a haemoglobinopathy on reproductive health. To evaluate best practice and alternative options in the management of patients with iron overload in a reproductive health setting.

Good Clinical Practice of the Italian Society of Thalassemia and Haemoglobinopathies (SITE) for the Management of Endocrine Complications in Patients with Haemoglobinopathies

“…The therapy of infertility is based on ovarian stimulation for targeted intercourse, first-level techniques (intrauterine insemination), and second-level techniques (in vitro fertilisation with embryo transfer (IVF-ET). The selection of the technique to be used should always consider the principle of graduality, together with other parameters, such as the age and basic conditions of the woman, the characteristics of the partner, AMH value, and the duration of infertility in women with menstrual cycles [ 37 , 38 , 39 , 40 , 41 ].…”

“…In writing these recommendations, the panel made reference to the following sources: [ 3 , 38 , 39 , 40 , 42 , 43 ].…”