Dados do Trabalho

Title

FUNCTIONAL OVARIAN RESERVE IN WOMEN WITH SICKLE CELL DISEASE: A SYSTEMATIC REVIEW

Objective

To carry out a systematic review on the evaluation of functional ovarian reserve in women with sickle cell disease.

Methods

The protocol for this systematic review was previously registered in PROSPERO, under registration number CRD42023432505. A search was performed in Pubmed, Science direct, SciELO, Lilacs, Clinical Trials, and CAFe databases, in addition to preprint servers and reference lists of selected publications, to locate studies that evaluated the ovarian reserve of women with SCD. Relevant original studies that used methodologies such as: cohort, case-control, cross-sectional study, and clinical studies, regardless of publication status, were eligible for inclusion. There were no restrictions on languages and date of publication. Two independent reviewers carried out the search, and the risk of bias in the selected studies was assessed using the Newcastle–Ottawa scale.

Results

1,086 records were initially retrieved after consulting the selected databases, and one article was identified after consulting the reference lists of the screened articles, only four articles met the eligibility criteria. The quality of evidence was rated very low due to the design of the studies, however, the risk of bias was considered low. These are recent studies published between 2015 and 2021, as for methodology, three cross-sectional studies and one case-control study were carried out, including a total of 229 adult women with SCD (HbSS, HbSC, and HbSβ). Two studies included a control group, totaling 156 women without SCD, matched by age and/or race. All studies reported lower levels of anti-Müllerian hormone (AMH) in women with SCD when compared to reference values for women of the same age without the disease. Although lower, AMH levels were within the normal range in young women with SCD only with supportive care, in those who used hydroxyurea (HU), a more significant decrease in ovarian reserve was observed and, in the participant, undergoing hematopoietic stem cell transplantation (HSCT), AMH levels indicated primary ovarian failure (undetectable AMH).

Conclusion

There is insufficient evidence to support a causal relationship between SCD and reduced ovarian reserve. From anti-mullerian hormone values, there appears to be a trend towards lower levels in women with SCD compared to healthy women, as reported in the four studies evaluated. Studies that analyze the ovarian reserve based on imaging and biochemical parameters are an important future focus.

Keywords

Sickle cell disease; sickle cell anemia; fertility; ovarian reserve; antimullerian hormone.