Reproductive choices in hemophilic men and carriers

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Abstract
We have examined reproduction patterns in hemophilic men and carrier women seen at a hemophilia treatment center. The study group included 309 patients with hemophilia A or B: 194 adults and 115 children from 246 pedigrees; 93% of affected men and 96% of parents of affected children had received genetic counseling. In the collected pedigrees, 65 % of affected males were born to women with family history of hemophilia. An additional 23% of mothers were later shown to be carriers. Fewer than 12% of cases could be due to a new mutation in the child. Among 209 hemophilia A carrier tests, 95% of obligate carriers were detectable, 87% of mothers of sporadic cases, 53% of sisters of hemophiliacs, and 24% of other relatives had a high risk of carriership. Of 49 high‐risk women seen during or prior to pregnancy, one‐half elected prenatal diagnosis. Amniocen‐tesis was performed in 24 cases and 8 were referred for fetoscopy, resulting in 18, normal offspring. Among 25 pregnancies not tested, 14 continued and produced 3 affected males and 11 normal offspring. Of hemophilic men over age 25, 66% have married and 41% (62% of those married) have had children. These obser‐vations will serve as a baseline for assessing any change in reproductive patterns occurring with the introduction of new genetic techniques.