Dados do Trabalho

Title

FUNCTIONAL OVARIAN RESERVE OF WOMEN WITH SICKLE CELL DISEASE

Objective

To evaluate the functional ovarian reserve in women with SCD using biochemical and ultrasound markers.

Methods

A cross-sectional study was carried out in the Municipal Care Program for People with Sickle Cell Disease. Fifty-nine participants who met the eligibility criteria were recruited for the study. Data collection was performed in three stages: clinical evaluation, laboratory evaluation, and ultrasound evaluation. Each participant's hemoglobin genotype was confirmed by hemoglobin electrophoresis. The collection of biological samples was carried out in an accredited laboratory accredited to conduct the study. The team that conducted the trials needed to be made aware of the characteristics of the participants and followed good laboratory and clinical practices. The biological material was discarded after analysis. The collection took place during the follicular phase (between the first and fourth day of the menstrual cycle) to determine the levels of LH, FSH, estradiol, sex hormone binding globulin (SHBG), anti-Mullerian hormone, ferritin, blood count, Complete and hemoglobin electrophoresis. Although AMH could have been performed on other days of the cycle, it is well established that FSH and estradiol for assessing ovarian reserve should be performed in the early follicular phase and CFA. For anti-Mullerian hormone analysis, serum and plasma samples were tested using the Access2 Immunoassay System test (Beckman Coulter), and the antral follicle count was performed using two-dimensional ultrasound.

Results

Fifty-nine women with a mean age of 34 ±10 years were evaluated. Most were diagnosed with the HbSS genotype and β-thalassemia (62.7%). Median AMH serum levels were 1.0 ng/mL (0.1 - 1.5 ng/mL). Lower levels of AMH were demonstrated among participants with HbSS hemoglobinopathy and β-thalassemia compared to participants with HbSC and HbCC hemoglobinopathy (0.5 ng/mL (0.1 – 2.2 ng/mL) vs 1.3 ng/mL). mL (0.0 - 3.2 ng/mL)). AMH values were lower in women who used oral contraceptives compared to those who did not use 0.58 ng/mL (0.14 – 2.37 ng/mL) x 1.08 ng/mL (0.28 – 2.57 ng/mL) (p=0.632), and in women who used Hydroxyurea, 0.45 ng/mL (0.01 – 1.9 ng/mL) x 2.47 (0.5 – 3.56 ng/ml), respectively. The median number of total antral follicles was 12 (7.5 – 15.3), and the median volume of ovaries was: direct ovary 7.95 cm³ (5.63 – 11.1cm³) and left ovary 6.1 cm³ (4.18 – 7.68 cm³). Only one participant had ultrasonographic parameters suggesting a meager functional ovarian reserve (total CFA = 3).

Conclusion

The study demonstrated decreased functional ovarian reserve in women with SCD; at least half of the women have AMH values lower than 1.0 ng/mL. These levels are lower than those observed in healthy women in the age group studied.

Keywords

Sickle Cell Disease, Fertility, Ovarian reserve, Anti‑Mullerian hormone, Haemoglobinopathy.