The medical community acknowledges "the paucity of knowledge on fertility in women with SCD," according to the authors of a systematic review of literature on fertility challenges for women with SCD published in 2017 in the journal Expert Review of Hematology. Still, they also suggested that those women "have additional risk factors that can impact their ability to conceive and include chronic inflammation, oxidative stress, transfusion-related hemochromatosis, and ovarian sickling leading to ischemia and reperfusion injury to the ovary."
In addition, evidence suggests the onset of menarche (menstruation) and puberty can be delayed if you have SCD.
"Delayed puberty is more frequent in sickle cell anemia HbSS phenotype compared to the HbSC phenotype," Ribeil said in an email. "However, the patients should be aware that normal maturation will occur."
But other problems pertaining to getting pregnant can arise.
Fertility requires three physiological components, according to Emily Jungheim, M.D., M.S.C.I., the chief of reproductive endocrinology and infertility in the department of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine in Evanston, Illinois.
"You need eggs, you need sperm and you need a uterine cavity," Jungheim said. "And in a woman with sickle cell disease, there's nothing wrong with her uterus or her fallopian tubes, and there's nothing, quite frankly, wrong with her eggs. The problem is oftentimes these women aren't ovulating."
She said women who are chronically ill often don't ovulate regularly.
"And in the case of someone who has sickle cell, what you would see most often is that they're not ovulating, simply because they're not getting the appropriate input into their ovaries to stimulate growth of follicles," Jungheim said. "That's required to get a mature egg that can then be ovulated."
Women with SCD who are ovulating may experience unpredictable ovulation.
"It's difficult to time intercourse before conception when you don't know if or when you're going to ovulate," Jungheim said. "It just makes it quite difficult to be able to conceive naturally. And so women in that scenario may need medications to help them ovulate so that they can predict [the] timing of sperm exposure so they can conceive."
Insufficient or largely absent estrogen production due to a lack of input from the hypothalamus also leaves the ovaries in a state that approximates constant rest and negatively affects both reproduction and bone health, Jungheim said.
Determination of premature ovarian insufficiency in women with SCD has been based on estimates from observational studies looking at total pregnancy rates, which have been lower than the general population. However, the data are not adequate to draw firm conclusions, according to the authors of a 2020 paper published in the journal Transplantation and Cellular Therapy. As of their writing, no study had "specifically found premature ovarian insufficiency in women with SCD who had no history of potentially sterilizing treatments."