Background: Recent therapeutic advances have resulted in prolonged survival of thalassemia major patients reaching adulthood and attaining reproductive capacity. However, endocrine complications are commoner in thalassemia major patients with up to 30% of patients showing hypogonadotrophic hypogonadism. Although spontaneous pregnancy have been described in well chelated and transfused patients, majority of thalassemia major patients are infertile and need assisted reproductive techniques (ART). We report our experience of fertility treatment in thalassemia major patients at our centre. Case series review: Case reports of six patients with thalassemia major who were referred for fertility treatment between 20002011 were reviewed. Case 1 and case 2 were south Asian males with thalassemia major and hypogonadotrophic hypogonadism and monthly blood transfusion. Their sperm count showed azoospermia and they were started on twice weekly HCG injections at a starting dose of 15002000 IU along with FSH injections at a starting dose of 75 IU thrice weekly. HCG dose was increased to 10,000 - 15,000 IU twice weekly and FSH dose was increased to 150225 IU thrice weekly without any success and repeat sperm count showing azoospermia. Case 3 and Case 4 were south Asian females with thalassemia major and hypogonadotrophic hypogonadism on regular blood transfusion. They were offered 1 cycle of IVF treatment with 6 ampoules of HMP for 8 days. The procedure failed and both the patients proceed to ovum donation. Case 5 was a south Asian female awaiting funding for IVF treatment whereas case 6 was an eastern European female whose hysterosalpingogram had shown blocked fallopian tubes and she is currently awaiting surgical treatment for blocked fallopian tubes before being referred for IVF Treatment.
Conclusion: This case series review showed poor treatment outcome for fertility in thalassemia major patients at our centre requiring closer liaison between hematologist, endocrinologist and gynecologist for successful treatment of such patients.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.