Evaluation of ovarian reserve, aging and fertility preservation in women with sickle cell disease

项目摘要/摘要 镰状细胞病(SCD)是最常见的单基因疾病之一，影响30多万新生儿 全世界每400人中就有1人是非洲人。在过去的几十年里，SCD已经从一种威胁生命的 从儿童期的疾病到成人的慢性病。随着存活率的提高和与疾病相关的减少 在发病率方面，生殖健康正在成为SCD护理中的一个优先事项。然而，适当的生育咨询 由于我们对SCD和疾病的影响缺乏了解，治疗建议受到限制。 修改生殖疗法。迫切需要评估生育率和优化生育率。 受SCD影响的女性的保留选择。本提案的目标是评估SCD如何 影响卵巢储备和女性生育力，并确定什么是保存的最佳时机和方法 生育能力存在于这些女性身上。中心假说是SCD通过以下途径导致卵巢加速衰老 慢性组织缺氧和炎症，对SCD妇女的生育能力产生不利影响。利用我们的 补充专业知识和现有的成人SCD临床研究计划，我们建议如下 为实现我们的目标而进行的研究：目标1.测量患有SCD和以下疾病的成年女性的卵巢储备 纵向上是两年多。目标2.在妇女试点队列中建立最佳生育保护方案 与SCD合作并优化其辅助生殖过程中发生的任何不良事件的管理 治疗。目的3.评价卵巢颗粒细胞的老化加速和炎症反应 来自SCD女性，与年龄匹配的非SCD对照组进行比较。这些研究将首先 从临床和分子水平系统评价SCD对卵巢衰老和女性生育力的影响 级别。这项工作将显著提高我们向患有SCD的妇女提供关于她们不孕风险的咨询的能力 这些风险是如何随着年龄和疾病严重程度而改变的。这笔赠款将为更多的 青春期女性SCD的卵巢病理生理学综合研究 在这一年轻人群中，在终末器官损伤发生之前保留生育能力。初步数据 从这项研究中获得的数据也将作为建立国家登记以监测生育率的基础 寻求生育力评估和治疗的SCD妇女的保存方法和长期结果 治疗。这些调查将增加我们对SCD如何影响女性生育和服务的了解 所有SCD妇女未得到满足的生殖健康需求。

PROJECT SUMMARY/ABSTRACT Sickle cell disease (SCD) is one of the most common monogenic diseases affecting over 300,000 births worldwide and 1 in 400 of African descent. In the last few decades, SCD has evolved from a life-threatening disease of childhood to a chronic disease in adults. With improved survival and reduced disease-related morbidity, reproductive health is emerging as a priority in SCD care. However, appropriate fertility counseling and treatment recommendations are limited by our lack of understanding of the impact of SCD and disease- modifying therapies on reproduction. There is an urgent need to evaluate the fertility and to optimize fertility preservation options in women affected by SCD. The objectives of this proposal are to evaluate how SCD affects ovarian reserve and female fertility, and to determine what the best timing and methods to preserve fertility are in these women. The central hypothesis is that SCD leads to accelerated ovarian aging through chronic tissue hypoxia and inflammation, which adversely affects the fertility of women with SCD. Utilizing our complementary expertise and an existing adult SCD clinical research program, we propose the following studies to achieve our objectives: Aim 1. Measure ovarian reserve in adult women with SCD and follow longitudinally over two years. Aim 2. Establish optimal fertility preservation protocol in a pilot cohort of women with SCD and optimize the management of any adverse events that occur during their assisted reproductive treatments. Aim 3. Assess ovarian aging acceleration and inflammation in the ovarian granulosa cells obtained from women with SCD, as compared with age-matched non-SCD controls. These studies will the first to systematically evaluate the impact of SCD on ovarian aging and female fertility from both clinical and molecular levels. This work will significantly improve our ability to counsel women with SCD on their risks of infertility and how these risks are modified by age and disease severity. This grant will lay important groundwork for a more comprehensive study on ovarian pathophysiology in adolescent females with SCD, with the goal of optimizing fertility preservation prior to onset of end-organ damage in this younger population. The preliminary data obtained from this study will also serve as the basis for establishing a national registry to surveil fertility preservation approaches and long-term outcomes in women with SCD seeking fertility evaluation and treatments. These investigations will increase our understanding of how SCD impacts female fertility and serve the unmet reproductive health needs of all women with SCD.