Iron overload disorders in adults: a comprehensive review of gonadal function, reproductive, and sexual health.
Francesco Carlomagno, Marta Tenuta, Andrea Sansone et al.
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In 30 seconds
This systematic review examined gonadal function, fertility, sexual health, and pregnancy outcomes in adults with iron overload disorders, including thalassaemias, hereditary haemochromatosis, and transfusion-dependent anaemias. Across pooled data, hypogonadism was reported in 47.0% of 1201 men; among men assessed for spermatogenesis, 17.6% had azoospermia and 37.5% had other sperm abnormalities. In women, primary amenorrhoea was reported in 45.7% and secondary amenorrhoea in 20.0%. The review also found substantial pregnancy-related intervention and complication burdens, while evidence that chelation reverses established reproductive dysfunction remains limited.
Key findings
- Hypogonadism was reported in 47.0% of 1201 men with iron overload disorders.
- Among men assessed for spermatogenesis, 17.6% had azoospermia and 37.5% had other sperm abnormalities.
- In women, primary amenorrhoea was reported in 45.7%, secondary amenorrhoea in 20.0%, and mean age at menarche was 14.4 ± 2.1 years.
- Across 3536 pregnancies, ART was required in ∼20%, miscarriage occurred in 11.2%, and caesarean section was used in ∼80%.
Why it matters
The review brings together evidence that iron overload can affect reproductive function through gonadal and hypothalamic-pituitary mechanisms, alongside broader endocrine and metabolic complications. It highlights gaps in assessment—particularly the absence of research on female sexual health—and supports attention to reproductive outcomes within care and future research, rather than focusing solely on systemic iron burden.
What to keep in mind
The review reports gaps in study design and diagnostic criteria, and notes that evidence for reversal of established reproductive dysfunction with chelation is limited. Female sexual health has not been investigated.