Accelerated age-related decline in ovarian reserve in sickle cell disease. An ovary is shown (large, yellow oval) undergoing an accelerated loss of eggs (small, light-orange circles) over time. Untreated or poorly-treated sickle cell disease damages multiple tissues and organs by multiple mechanisms. Disease-related, direct ovarian damage could lead to an accelerated loss of egg supply and diminished ovarian reserve. Hydroxyurea decreases clinical severity and organ damage in sickle cell disease, potentially preserving ovarian reserve. Theoretically, the potential cytotoxic effects of hydroxyurea on ovarian reserve could partially offset this benefit. Assessment of ovarian reserve can allow early and equitable discussions about fertility preservation.