# Reproductive Health of Young Adult Women Who Have Sickle Cell Disease

> **NIH NIH R21** · EMORY UNIVERSITY · 2020 · $195,000

## Abstract

Project Summary
Improvements in medical care have transitioned sickle cell disease (SCD) from a disease of childhood into a
long-term chronic illness. As people who have SCD become adults, parenthood becomes an important life goal
for many, but little is known about their reproductive potential. Hydroxyurea, a common treatment for SCD, has
been associated with decreased sperm count, but parallel studies of ovarian reserve in adult women do not
exist. Ovarian reserve decreases naturally as women approach menopause, but gonadotoxic treatments may
accelerate the onset of menopause resulting in a shortened period in which to have children as well as earlier
onset of menopause sequelae such as sexual dysfunction, cardiovascular disease, and low bone density.
Blood transfusion is also an important therapy for SCD, but repeated transfusions (chronic or episodic) result in
iron overload, the accumulation of iron in some organs and tissues. In women with transfusion-dependent β-
thalassemia, this has been associated with decreased ovarian reserve, which may reflect iron accumulation in
the ovary. Further, iron toxicity to the anterior pituitary may impair production of gonadal hormones. A study of
iron overload in adolescents with SCD and studies of women with transfusion-dependent β-thalassemia
appear to support this possibility. Further, in women with transfusion-dependent β-thalassemia, the prevalence
of hypogonadotropic hypogonadism and amenorrhea are high. Thus, there are plausible mechanisms by which
SCD treatments and complications may shorten the reproductive window of women with SCD and affect their
fertility, but there are almost no studies of reproductive health in this vulnerable population. We will address
this gap through the following aims: 1) We will determine whether women with SCD have lower ovarian reserve
than women without SCD and 2) We will determine whether women with SCD are at increased risk of infertility
compared with women without SCD. We will evaluate these aims by iron overload status and by treatment with
hydroxyurea. We are uniquely positioned to complete the proposed work because we will recruit women from
the Grady Hospital Comprehensive SCD Clinic, which serves the largest SCD patient population in the country.
Further, we will build on our extensive prior experience studying reproductive health in cancer survivors and in
women with lupus. Women with SCD, predominately African American women living in metropolitan Atlanta,
will be compared with a population-based sample of African American women living in metropolitan Atlanta that
we recruited previously. We will assess ovarian reserve based on serum anti-Müllerian hormone. Infertility will
be defined several ways including as not getting pregnant after 12 months of regular, unprotected intercourse.
Our previously developed, in-depth interview will provide information on infertility and potential confounders.
We will abstract hydroxyurea, iron overload, and SCD care info...

## Key facts

- **NIH application ID:** 10060165
- **Project number:** 1R21HD103030-01
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Penelope P. Howards
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $195,000
- **Award type:** 1
- **Project period:** 2020-07-15 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10060165

## Citation

> US National Institutes of Health, RePORTER application 10060165, Reproductive Health of Young Adult Women Who Have Sickle Cell Disease (1R21HD103030-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10060165. Licensed CC0.

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