Sao Paulo State Univ UNESP, Ctr Human Reprod Prof Franco Jr, Paulista Ctr Diag Res & Training, Dept Gynecol & Obstet,Botucatu Med Sch, Ribeirao Preto, Brazil
Objective: Spontaneous fertility and successful pregnancies have been reported in well-chelated and transfused women with beta thalassaemia major (BTM) however majority of women are sub fertile due to hypogonadotropic hypogonadism (HH) and lack of ovulation. Little is known about the effect of iron overload on ovarian follicles and whether ovarian reserve is affected by the condition or treatment. The predictive value of markers of ovarian reserve in relation to live birth in this group of women remains unclear. The aim of this study was to characterize the markers of ovarian reserve in women with transfusion-dependent beta thalassaemia major who had at least one successful live birth. Study design: This is a retrospective study in which we collected data from 12 women with transfusion-dependent BTM and at least one successful live birth from our thalassaemia clinic between July 2007 to June 2022. Patient demographics, medical history, menstrual history, hormonal parameters (serum levels of FSH, oestradiol, TSH and AMH) and antral follicle count were recorded. Serum levels of ferritin, cardiac T2*, liver iron concentration and thyroid function results were recorded from clinic visit prior to either natural conception or assisted conception treatments. Results: There was a wide variation in serum levels of AMH and antral follicle counts amongst women with BTM who had a successful live birth. Low serum AMH levels were noted in 4 women with HH with a background of BTM (33.3%) as compared to the established normal ranges for women of similar age. Also, low AFC counts were noted in 7 women (out of which 6 had HH) with BTM (58.3%) as compared to the established normal ranges for women of similar age. Conclusion: Levels of serum AMH and antral follicle counts appeared lower in up to half the women with BTM and hypogonadotropic hypogonadism with a successful live birth as compared to established normal ranges for women of similar age suggesting that these markers may not accurately reflect the ovarian reserve for all in this group of women. There are limited data about the predictive value of contemporary markers ovarian reserve such as serum AMH and AFC levels in predicting successful fertility or pregnancy outcomes in women with transfusion dependent BTM and larger studies are needed.
Abstract Study question Does iron overload affect ovarian reserve markers in women with transfusion-dependent beta thalassaemia major? Summary answer Ovarian reserve markers were lower in women with transfusion dependent beta thalassaemia major as compared to controls suggesting an impact of iron overload on ovary What is known already Although spontaneous fertility and successful pregnancies have been reported in well-chelated and transfused women with beta thalassaemia major (BTM), majority of women are subfertile due to hypogonadotropic hypogonadism (HH). Little is known about the effect of iron overload on ovarian follicles and whether ovarian reserve is affected by the disease or treatment status. Study design, size, duration This study compares the markers of ovarian reserve in women with transfusion-dependent beta thalassaemia major over a period of ten years with healthy women from a control population. It is a 10-year mixed (retrospective and prospective) longitudinal study in 17 women with transfusion-dependent beta thalassaemia major from thalassaemia clinic in a tertiary teaching hospital between July 2007 to June 2017. The results were compared with 52 age-matched healthy women without any medical conditions (control population). Participants/materials, setting, methods Study compared 17 women with transfusion-dependent beta thalassaemia major with 52 age-matched healthy women without any medical conditions attending fertility clinic. Patient demographics, medical history, menstrual history, hormonal parameters (serum levels of FSH, estradiol, TSH and AMH) and antral follicle count (AFC) were recorded in all women from both groups. Serum levels of ferritin, cardiac T2*, liver iron concentration, thyroid function (TSH) and liver function test results were also recorded at three different time points. Main results and the role of chance Serum AMH levels, estradiol levels and antral follicle count were significantly lower in women with beta thalassaemia major compared with the control group (p < 0.05 for all). Low AMH levels were noted in both groups of women (with and without hypogonadotropic hypogonadism) with a background of beta thalassaemia major. Due to part retrospective nature of study, bias arising from patient selection and completeness of information available from medical records cannot be entirely ruled out. Limitations, reasons for caution The sample size was small, and bias cannot be entirely ruled out due to part retrospective nature of the study. We could not verify how many of the BTM women with amenorrhoea needed induction of puberty with certainty. Wider implications of the findings The belief that the gonad might be spared from effects of transfusional iron overload in women with BTM is questionable. Ovarian reserve markers were significantly lower in women with transfusion dependent BTM compared to controls. Further studies are required to elucidate mechanisms by which iron overload can adversely affect ovaries. Trial registration number Not applicable
Current management strategies to prevent fetal intracranial haemorrhage in perinatal alloimmune thrombocytopenia (PAIT) include serial platelet transfusion and/or maternal high-dose intravenous immunoglobulin (IVIG) administration. The former involves multiple invasive procedures, while the latter is both expensive and of questionable efficacy. We report the use of direct fetal IVIG in 2 fetuses with PAIT, undergoing serial intrauterine platelet transfusions. Fetal IVIG had no effect on fetal platelet count. We conclude that direct fetal IVIG administration does not appear to have a role in the management of PAIT, and that current management strategies remain far from ideal.
Twin pregnancy has a disproportionate effect on perinatal mortality, being six times higher than for singleton gestations. The major threats to perinatal survival are from two very different pathological processes: spontaneous preterm delivery, and the interlacing clinical complications of monochorionicity. With the realization that perinatal loss/handicap is higher in monochorionic than dichorionic twins, attempts have been made in the last decade to assign chorionicity ultrasonographically, using single or composite parameters, such as number of placental masses, fetal sex, septal thickness and twin peak signs. Such knowledge will allow (a) risk stratification of twin gestations, (b) appropriate selection of prenatal screening and diagnostic methods, (c) vigilant monitoring for early diagnosis of twin-twin transfusion syndrome and growth restriction, and (d) management of preterm labour, congenital malformation, single intra-uterine death and polyhydramnios. By contrast, prospective knowledge of zygosity is unlikely to influence perinatal outcome, since approximately 25 per cent of monozygous conceptions have dichorionic placentation. Postnatal determination of zygosity in like sex twin pairs with dichorionic placenta is important for the future consideration of organ transplantation compatibility and to evaluate the genetic component of various diseases.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
