Fertility Concerns and Access to Care for Stem Cell Transplantation Candidates with Sickle Cell Disease

•Sickle cell disease (SCD) and its treatments, especially alkylating agents and radiation used in hematopoietic cell transplantation (HCT), are damaging to fertility in both men and women.•Patients with SCD face multiple factors contributing to poor quality of life and have high rates of depression, which infertility may compound.•Fertility-preserving treatments are variably accessible and often very expensive.•Researchers and clinicians have important roles in advocating for patients with SCD in general, and in particular for the subset facing iatrogenic infertility due to HCT. Sickle cell disease (SCD) affects 100,000 Americans and causes significant psychiatric illness and poor quality of life in many domains, including infertility. Hematopoietic cell transplantation (HCT) is the only available cure for SCD, but it can entail chronic toxicities, including psychiatric conditions, such as depression and anxiety, and sterility in both men and women. There is scant literature on fertility or psychiatric outcomes for patients with SCD receiving HCT, and none considering the additive ramifications of the stresses of SCD, transplantation, and infertility. Financial toxicity is a significant concern for all patients undergoing HCT. Treatment for infertility is also very expensive, and access to fertility services is variable in the United States, adding to the medical and quality of life burden for this patient population. Here we review the relevant areas of SCD and infertility, SCD and psychiatric wellness, access to care, and infertility and quality of life. Collectively, these data suggest that the group of patients with SCD who undergo HCT and experience infertility are at particularly high risk for poor quality of life, worsening psychiatric health, and poor access to adequate fertility treatment.