SCD and Fertility: Why affected women need hormonal and mental health care

Hyderabad: Sickle Cell Disease (SCD) is a group of genetically inherited blood disorders which require lifelong management with medications as it affects various aspects of health.

The condition results in abnormal haemoglobin, causing the red blood cells to become rigid and ‘sickle’ in shape. These cells can block the blood flow, leading to pain, damage to organs and other complications.

SCD and women’s health

SCD severely impacts women’s fertility and reproductive health. The chronic condition causes irregular, painful menstrual cycles and can delay puberty. Additionally, women with SCD face increased risks during pregnancy, including preeclampsia, preterm labour and painful crises that may require hospitalisation. The disease can affect ovarian function, potentially leading to reduced fertility.

Dr Avanthi Vellala, a consultant fertility specialist at Oasis Fertility Hospital, said, “Women with SCD wishing to preserve their reproductive potential require a smooth balance between hormonal stability and hopeful family planning.”

Ways to manage SCD

Preserving fertility in women is more complex than in men affected by SCD, since SCD leads to ovarian ageing, menstrual irregularities and complications during pregnancy.

“Hydroxyurea, one of SCD management methods, has become popular for its effectiveness in reducing the frequency of painful crises and the need for blood transfusions. However, it does affect fertility, especially in men, by lowering the sperm count and quality,” Dr Avanthi said.

The side effects can be reversed by stopping the consumption of drugs, but uncertainty prevails, which causes emotional distress for individuals and couples who are keen to have children.

According to Dr Avanthi, hydroxyurea is safe for female fertility, but recommended to discontinue the medication during pregnancy as it harms the fetus. “By doing so, it again causes an increase in SCD symptoms, thereby creating a challenge between maternal health and foetal safety,” she added.

Preimplantation genetic testing

Advancements in reproductive medicine offer hope. Fertility preservation methods, such as egg or sperm freezing before starting hydroxyurea or undergoing stem cell transplants, are becoming more accessible. By consulting haematologists, fertility specialists and obstetricians, one can protect both fertility and overall health.

“Preimplantation genetic testing plays a crucial role in helping couples with sickle cell disease have healthy, unaffected children. By utilising IVF+PGT, couples can identify and select the embryos that don’t carry the sickle cell mutation, which significantly reduces the risk of passing the disease to their offspring,” Dr Avanthi said.

Importance of contraception

Furthermore, contraception plays a key role in individuals with SCD.

Unplanned pregnancies in women with SCD carry high health risks and the choice of contraception must consider the potential for blood clots and hormonal side effects that could exacerbate SCD symptoms.

Dr Avanthi explained about managing fertility under SCD, which requires both medical supervision and emotional resilience and well-informed choices. “Patients no longer have to choose between managing their illness and looking forward to a family life, thanks to growing awareness and research. Although juggling hormones and hope is a complex process, it can result in rewarding outcomes with the correct assistance. Finally, the ability of people with SCD to flourish in all facets of life, including the desire to become parents, is growing along with scientific understanding,” she said.