Risk of infertility among women with sickle cell disease.
Level 3 - non-randomized controlled study
Retrospective cohort study with a comparison group
PubMed 42155915 · doi:10.1016/j.fertnstert.2026.05.153
What was done
Retrospective cohort study comparing 129 women aged 20 to 45 years with sickle cell disease (SCD) recruited from a clinic in Atlanta, Georgia, to a comparison group of 236 Black women aged 20 to 45 living in Atlanta. Infertility measures were derived from interview questions assessing unprotected-intercourse infertility (≥12 months of unprotected intercourse without pregnancy) and attempting-pregnancy infertility (≥12 months of attempting pregnancy). For women with SCD, hydroxyurea use and chronic transfusion therapy were ascertained from medical records.
What was found
Women with SCD had higher point estimates for unprotected-intercourse infertility (adjusted hazard ratio [aHR]: 1.4, 95% CI: 0.9–2.2) and attempting-pregnancy infertility (aHR: 1.2, 95% CI: 0.4–2.5) compared to control women, though neither reached statistical significance. Among women with SCD, those treated with hydroxyurea had an aHR of 1.4 (95% CI: 0.8–2.7) for unprotected-intercourse infertility. Over 25% of women with SCD were dissatisfied with information received regarding how SCD and its treatments affect pregnancy, and most had never discussed the topic with a healthcare provider.
Why it matters
The findings indicate potential fertility risks and underscore a clear gap in clinical communication and reproductive counseling for women living with sickle cell disease.
Limits
Sample size was limited (n = 365 total), resulting in imprecise estimates with confidence intervals spanning the null. Infertility outcomes were self-reported via interviews rather than objectively confirmed clinical diagnoses, introducing risk of recall or reporting bias. The study was conducted in a single metropolitan area.
Cited by
- supports Infertility is clinically defined as attempting to achieve pregnancy for 12 months without success.