Ovarian Reserve in Women of Reproductive Age With Sickle Cell Anaemia: A Scoping Review
Kehinde Awodele, Sunday Charles Adeyemo, Adeniyi Olanipekun Fasanu, John Oluwadamilola Ojo, Haruna Oche AhmaduABSTRACT
Background
Sickle cell anaemia (SCA) is an inherited haemoglobinopathy disproportionately common among people of African origin, though it affects multiple global populations. Emerging evidence suggests that chronic haemolysis, inflammation and treatment exposures in SCA may affect ovarian function. This scoping review aimed to map available evidence on ovarian reserve in women of reproductive age with SCA.
Methods
PubMed/MEDLINE, Embase, Scopus, Web of Science and CINAHL were searched from inception to 31 January 2026, using Boolean operators combining terms related to SCA, ovarian reserve, anti‐Müllerian hormone (AMH), antral follicle count (AFC) and follicle‐stimulating hormone (FSH). Studies reporting biochemical or radiographic ovarian reserve in reproductive‐aged women with SCA were included. Due to heterogeneous methodologies, data were extracted via standardised forms and narratively synthesised.
Results
Seven studies met the inclusion criteria, comprising six observational studies and one retrospective multi‐centre fertility preservation cohort (total N = 488 women with sickle cell disease, of whom the large majority had HbSS). The majority of comparative studies reported lower AMH levels in women with SCA compared to controls, with reductions ranging from 48% to 79% depending on the population and assay method. Direct pooling was not performed due to assay heterogeneity. Lower AFC was also observed in studies reporting this measure. Studies that compared HbSS with HbAA controls consistently reported lower AMH and AFC, whereas data on HbSC and HbSβ° genotypes were too sparse to permit formal genotype comparison. Age demonstrated a stronger negative correlation with ovarian reserve markers among women with SCA compared to controls. Evidence on FSH was limited and inconsistent. Treatment‐related findings, particularly regarding hydroxyurea exposure, were reported but causality could not be established due to confounding by disease severity.
Conclusion
The available evidence indicates that women of reproductive age with SCA, particularly those with HbSS genotype, may demonstrate lower ovarian reserve indices compared to age‐matched HbAA controls, though the cross‐sectional nature of most studies limits causal inference. These findings highlight the need for early reproductive counselling and further longitudinal research.
Trial Registration
The authors have confirmed clinical trial registration is not needed for this submission.