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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (1): 122-125    DOI: 10.31083/j.ceog.2020.01.5074
Original Research Previous articles | Next articles
Myocardial iron is strongly associated with reproductive function in beta-thalassemic women under chelation therapy
M. A. Castaldi1, 2, *(), C. Fulgione2, L. Marino2, S. G. Castaldi2, L. Giugliano2, C. Selleri2, M. Guida2, V. Frega3, L. Cobellis3, A. Filosa4, M. Casale4
1Department of Maternal and Child Health, Operative Unit of Obstetrics and Gynaecology, A.O.R.N. S.G. Moscati, Contrada Amoretta, Avellino, Italy
2Department of Medicine and Surgery, University of Salerno, Salerno, Italy
3Department of the Woman, the Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
4UOSD Microcitemia, AORN A. Cardarelli, Naples, Italy
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Abstract  

Objective: To evaluate gynaecological features of a group of transfusion dependent beta-thalassemic women and to analyze their reproductive function with the morpho-functional features of genital female tract. Materials and Methods: Cross-sectional study in a University Hospital and Tertiary Care Center. Fifty-nine transfusion-dependent beta-thalassemic women in reproductive age, were divided into two groups: to group A were assigned women with spontaneous menarche (n=44), while to group B were allocated patients with inducted menarche. Data on demographic characteristics, iron overload in liver and heart (evaluated with T2* RMN method), chelation therapy, and reproductive function were collected. Difference in demographic characteristics, chelation therapy, iron status, and reproductive function between groups were assessed, together with correlation analysis of iron overload. Results: Patients in group B had a worse reproductive function and a higher myocardial iron overload, than patients in group A. Moreover multivariate logistic regression showed a significant correlation between uterine biometry, FSH, E2, parity and hearth iron T2*HSIV, but not with liver iron. Conclusion: The present data shows that myocardial iron loading could be putative of prolonged and severe iron overload in the female genital tract, impairing fertility and reproductive function in patients affected with beta-thalassemia major under chelation therapy.

Key words:  Beta-thalassemia major      Myocardial iron overload      Liver iron overload      Reproductive function      Chelation therapy     
Published:  15 February 2020     
*Corresponding Author(s):  M. A. Castaldi     E-mail:  mantocastaldi@msn.com

Cite this article: 

M. A. Castaldi, C. Fulgione, L. Marino, S. G. Castaldi, L. Giugliano, C. Selleri, M. Guida, V. Frega, L. Cobellis, A. Filosa, M. Casale. Myocardial iron is strongly associated with reproductive function in beta-thalassemic women under chelation therapy. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(1): 122-125.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.01.5074     OR     https://ceog.imrpress.com/EN/Y2020/V47/I1/122

Table 1  — Characteristics of the 59 beta-thalassemic patients enrolled in the study. 44 women had spontaneous menarche (group A) and 15 women had inducted menarche (group B).
Patients’ characteristics Group A (n=44) Group B (n=15) p value
Age (years) 37.8 ± 8.7 38.5 ± 6.9 0.786
Weight (kg) 57.3 ± 9.2 55.9 ± 8.9 0.641
Height (cm) 153.8 ± 8.5 157.2 ±7.9 0.653
BMI (kg/m2) 23.4 ± 3.4 24.1 ±5.1 0.237
Ferritin level (<1500 µg/L) Onset of transfusional 1136 ± 352 1279 ± 478 0.871
Therapy (months) 12 ± 6 13 ± 5 0.785
Age of menarche 13.2 ± 1.4 17, 3 ± 3, 4 <0.0001
Ongoing hormonal therapy 56,8% 93,3% <0.0001
Table 2  — Differences between group A (n= 44 patients with spontaneous menarche) and group B (n= 15 patients with inducted vaginal bleeding).
PARAMETER Group A (n= 44) Group B (n=15) Statistics 95%CI P-Value
Patients who underwent Ovarian Stimulation Cycles

20, 0%
(n=3)


20, 4%
(n=9)


OR
1, 060
0, 243-4, 621 0, 937
Pregnancy Rate (%) 36.3%
(n=16)
6.7%
(n=1)
OR
8, 000

7, 100-10, 300
0, 028
Uterine Biometry (mm) 67, 4 ± 13, 7 55, 9 ± 12, 4 T Student
2, 872

3, 870-19, 129
0, 020
T2*HSIV (msec) 31, 9 ± 11, 7 23, 2 ± 13, 6 T Student
2, 386

0.831-16.569
0, 043
T2 *L (msec) 8, 6 ± 7, 2 7, 9 ± 5, 8 T Student
0, 340

-3.004-4.404
0, 735
Table 3  — Multivariate logistic regression of age, menarche (spontaneous or inducted), age at menarche, FSH, LH, E2, parity, and uterine biometry, and heart and liver iron overload (dependent variables).
Independent
variable
P value #
Age 0, 347 0, 465
Menarche 0, 239 0, 381
Age at menarche 0, 876 0, 501
FSH 0, 041 0, 103
LH 0, 067 0, 184
E2 0, 023 0, 230
Parity 0, 016 0, 286
Uterine Biometry 0, 022 0, 459
Dependent variable T2* HSIVa T2*Lb
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