From Yellow Cumulus to Pregnancy in Autoimmune Hemolytic Anemia Following Bilirubin Reduction: A Case Report

Autoimmune hemolytic anemia (AIHA) is a systemic condition associated with inflammation and oxidative stress, both of which can negatively affect reproductive outcomes. Bilirubin, a byproduct of hemolysis, has been implicated in oocyte maturation and embryogenesis. We present the case of a 31-year-old patient with primary infertility who was known with AIHA. She had a total bilirubin level of 60 µmol/L prior to the first stimulation cycle, which was associated with yellowish pigmentation of the cumulus cells, poor oocyte quality, and no blastocyst formation. The decline in the total bilirubin level to 48 µmol/L after prednisone therapy of 60 mg daily for three months led to improved cumulus cell appearance and enhanced oocyte and embryo quality in the second stimulation cycle. A successful pregnancy was achieved following frozen blastocyst transfer in a natural cycle. This case underscores the importance of individualized assessment and the careful interpretation of elevated bilirubin levels in the context of assisted reproductive technology, as systemic conditions may potentially impact reproductive success.