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Expecting More: The Case for Incorporating Fertility Services into Comprehensive Sickle Cell Disease Care

In recent years, advances in the medical care of sickle cell disease including optimal blood transfusion, the use of hydroxyurea and newer disease-modifying agents, as well as proper antibiotic prophylaxis have significantly improved life expectancy and patients’ quality of life. Thus, the expectation of having a family is a need that has to be met for people with sickle cell disease and pregnancy planning is essential in both spontaneous and assisted reproductive technology conceptions.

In this context, the organization of specialized fertility centers for the management of pregnancy-related issues in individuals with sickle cell disease would be a milestone completed in their health. The role of fertility services centers could offer important medical and psychosocial help in all stages of pregnancy:

  • Before pregnancy, fertility centers would assess and counsel patients with sickle cell disease prior to conception and evaluate their baseline health status and review future parents’ medication and immunization status.

Also, management of infertility requires careful planning and preparation.

  • During pregnancy, those centers would offer routine prenatal evaluations and sickle-cell specific evaluations since early detection of sickle cell disease complications is essential for the health of both mothers and fetuses.
  • Discussion of the birth plan and timing of the delivery as well as the collection of umbilical cord blood specimen at the time of birth that may be harvested for use in hematopoietic stem transplantation for a relative with sickle cell disease.
  • Finally, post-partum care is also important for surveillance of maternal complications.
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