Hemoglobin diseases like sickle cell disease (SCD) and β-thalassemia (BT) present fertility challenges for affected patients. SCD and BT result from abnormal hemoglobin production or structure and pose numerous health concerns. Despite medical advancements improving the quality of life or even providing cures, SCD and BT pose unique fertility concerns for women. Young women with these disorders already contend with reduced ovarian reserve and a narrower fertile window, a situation that is compounded by the gonadotoxic effects of treatments like medications, transfusions, stem cell transplants, and gene therapy. While crucial for disease control, these interventions may lead to reproductive health issues, increasing infertility and early menopause risks. Ovarian tissue cryopreservation (OTC) offers potential for future motherhood to women with hemoglobin disorders facing infertility related to curative treatments. OTC involves surgically removing, preparing, and freezing ovarian tissue containing primordial follicles capable of producing mature oocytes, offering advantages over oocyte cryopreservation alone. However, the application of OTC for patients with hemoglobin disorders presents unique challenges, including special health risks, financial barriers, and access to care. This comprehensive literature review delves into the current state of ovarian tissue cryopreservation for fertility preservation in patients with hemoglobin disorders. Empowering patients with informed reproductive choices in the context of their hemoglobin disorders stands as the ultimate goal.

Single embryo transfer (SET) is a technique used in assisted reproductive treatment (ART) that is used to promote singleton pregnancies. To date, there are five reported cases of dizygotic twin pregnancies with mothers who underwent SET. Here, we present a sixth case of a dichorionic, diamniotic twin pregnancy with sex discordance. The patient is a 34-year-old woman with unexplained secondary infertility who underwent in vitro fertilization (IVF) and frozen-thawed embryo transfer from a SET. The ultrasonographic images from the first and second trimester scans identified dichorionic, diamniotic twin gestations. The delivery was full term and postnatal genetic testing confirmed 46, XX, and 46, XY offspring. Pathology reports of the placental and membrane findings reported diamniotic, dichorionic twins. There was no zygosity testing conducted, thus it is unknown if the twins are monozygotic or dizygotic. Two possible etiologies for sex-discordant twins, in this case, are concurrent natural conception via breakthrough ovulation at the time of SET, or discordant postzygotic nondisjunction of a single embryo. Multiple gestations may still occur in the setting of SET and zygosity testing in these instances would better elucidate our understanding of this occurrence. Moreover, improved data on the zygosity of multiple gestations following SET may enhance patient counseling.

A retrospective cohort study was conducted comparing conventional intracytoplasmic sperm injection (ICSI) with a pre-catching sperm (PCS)-ICSI technique. Cases with at least 0.5 million motile sperm and 5 mature oocytes were included. Conventional ICSI involves simultaneous loading of sperm and oocytes onto the dish, followed by identification, immobilization, and loading of sperm into pipettes for oocyte injection. In the PCS-ICSI technique, suitable sperm were identified and immobilized prior to oocyte loading onto the dish, thus reducing the oocyte exposure time. Variables of interest included rate of fertilized and degenerated oocytes, abnormal fertilization, quality blastocyst formation, and pregnancy outcomes. Statistical analysis utilized Student’s t-test and Fisher’s Exact Test. Our study included 330 PCS-ICSI and 287 conventional ICSI cases. Female age, BMI, AMH, total number of collected oocytes, and rate of abnormal fertilization were similar between groups. The PCS-ICSI group demonstrated an increased rate of oocyte fertilization (84.0% vs. 79.3%, p < 0.001), good quality blastocyst formation (54.9% vs. 48.0%, p < 0.001), and a lower rate of oocyte degeneration (1.4% vs. 3.5%, p < 0.001). Positive pregnancy rate, clinical pregnancy, and live birth rate were similar between groups. The expansion of this technique resulted in increased oocyte fertilization and good quality blastocyst formation, and decreased oocyte degeneration. Further studies will evaluate the effectiveness of this technique in broader patient populations.