Embryo Cryopreservation in a Patient with Sickle Cell Disease Utilizing Letrozole and Enoxaparin: A Case Report. Hematol Rep 2023 Feb 03;15(1):101-107
Date
02/23/2023Pubmed ID
36810554Pubmed Central ID
PMC9944850DOI
10.3390/hematolrep15010011Scopus ID
2-s2.0-85151092247 (requires institutional sign-in at Scopus site) 1 CitationAbstract
PURPOSE: To describe a patient with sickle cell disease, a prothrombotic disorder, who underwent successful embryo cryopreservation for the purposes of fertility preservation prior to hematopoietic stem cell transplant.
METHODS: To report a successful case of gonadotropin stimulation and embryo cryopreservation using the aromatase inhibitor letrozole to maintain low serum estradiol to minimize thrombotic risk in a patient with sickle cell disease (SCD) and history of retinal artery thrombosis planning hematopoietic stem cell transplant (HSCT). The patient was given letrozole (5 mg daily) as well as prophylactic enoxaparin while undergoing gonadotropin stimulation with an antagonist protocol to preserve fertility prior to HSCT. After the oocyte retrieval, letrozole was continued for one additional week.
RESULTS: The patient's peak serum estradiol concentration was 172 pg/mL during gonadotropin stimulation. Ten mature oocytes were retrieved and a total of 10 blastocysts were cryopreserved. The patient required pain medication and intravenous fluids after oocyte retrieval due to pain but had significant improvement at the scheduled post-operative day one follow-up. No embolic events occurred during stimulation or 6 months thereafter.
CONCLUSION: The utilization of definitive treatment for SCD with stem cell transplant is increasing. We successfully used letrozole to maintain low serum estradiol during gonadotropin stimulation along with prophylactic enoxaparin in a patient with SCD to minimize her risk of thrombosis. This approach will allow patients planning definitive treatment with stem cell transplant the opportunity to preserve their fertility safely.
Author List
Gunderson SJ, Snowden N, Field JJAuthors
Joshua J. Field MD Professor in the Medicine department at Medical College of WisconsinStephanie Gunderson MD Associate Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin
