Ovarian reserve and oxidative stress in sickle cell anaemia: a comparative cross-sectional study

Sickle cell anaemia (SCA), the most common monogenic disorder, affects 20-25 million people globally and is prevalent in Sub-Saharan Africa, especially Nigeria, where the prevalence is 1-3%. Beyond its haematological complications, SCA is associated with chronic anaemia and oxidative stress, which may adversely affect ovarian function; however, this relationship remains poorly understood. This study aimed to evaluate ovarian reserve in women with SCA using Anti-Mullerian Hormone (AMH) and Antral Follicle Count (AFC) and assess the role of oxidative stress. This was a comparative cross-sectional study, conducted at Lagos State University Teaching Hospital, over a 6-month period, in which 75 women with SCA (HbSS) in a steady/stable clinical state and 75 age-matched women with normal haemoglobin genotype (HbAA), were consecutively recruited. Relevant data was collected with the aid of interviewer-administered structured questionnaires. The study participants had their body mass index (BMI), venous blood AMH levels and oxidative stress markers (superoxide dismutase, glutathione peroxidase and malondialdehyde) levels, and transvaginal ultrasound for AFC assessed according to standard. Women aged < 18 or > 45 years and women on antioxidant medications were excluded. Data were analyzed using relevant inferential statistics with significance level set at 0.05%. HbSS participants had significantly lower median AMH (1.52 ng/ml, IQR 1.0-2.1) and AFC (12.0, IQR 9.0-13.0) compared to the HbAA group (AMH 3.80 ng/ml, IQR 2.7-7.8; AFC 15.0, IQR 12.0-16.0; p < 0.001 for both). Age showed a significant negative correlation with AMH and AFC in HbSS women (r = -0.301, p = 0.010; r = -0.360, p = 0.001). Superoxide dismutase levels were significantly reduced in the HbSS group (median 1.50 vs. 2.00 nmol/ml, p < 0.001), while glutathione peroxidase and malondialdehyde levels did not differ significantly. BMI and parity also differed, with HbSS women more likely to be underweight and nulliparous. Women with HbSS exhibited significantly lower ovarian reserve markers and altered oxidative stress profiles compared to their HbAA counterparts, with age emerging as a key determinant of ovarian reserve in HbSS. Within the oxidative stress parameters assessed, no significant correlation with ovarian reserve markers was observed. These findings suggest that other disease-related factors, beyond the oxidative stress indices measured in this study, may contribute to ovarian dysfunction in SCA.