The global disease burden of end stage renal disease ESRD is growing rapidly, and organ transplantation remains the gold standard for improving both the quality and quantity of life particularly in young adults. It is therefore critical to understand the effect of ESRD and renal transplantation on male fertility. Many men in renal failure exhibit subfertility or infertility due to several factors including hypogonadism, erectile dysfunction ED, and direct impairment of spermatogenesis with spermatotoxicity and late stage maturational arrest causing oligospermia or azoospermia. Kidney transplantation has been shown to rescue some—but not all—of these defects, with normalization of reproductive hormonal parameters, improvement in semen parameters sperm count, motility, morphology, and partial restoration of erectile function. This improvement in fertility is sufficient for a subset to father children either naturally or with assisted reproduction. In this review, we summarize the literature regarding fertility in men with chronic kidney disease CKD and on dialysis, and we describe the changes associated with renal transplantation.
Two small case series have demonstrated feasibility for this approach. The National Transplantation Pregnancy Registry NTPR recently published paternity data on male transplant patients maintained on mycophenolic acid-based medications The decline of fertility in male uremic patients is correlated with low expression of the cystic fibrosis transmembrane conductance regulator protein CFTR in human sperm. In utero exposure to mycophenolate mofetil: A characteristic phenotype? In theory, both of these effects could have significant deleterious effects on spermatogenesis, and indeed this has been seen in practice. Sirolimus, everolimus, and temsirolimus are inhibitors of the mammalian target of rapamycin mTOR and PI3K pathways and thus suppresses immunity as well as neoplastic processes. We explore the changes in reproductive hormones, semen quality, erectile dysfunction ED, and paternity with renal transplantation. JIMD Rep ; 38 The gray areas and dotted lines represent the range of values seen in healthy fertile males.
Because of a marked pituitary dysfunction, which is not reversed by dialysis, infertility is frequently a problem in male patients with chronic renal failure CRF. Therefore, any additional cause of infertility can further and dramatically decrease the ability of patients with CRF to conceive. No other relevant disease had been diagnosed before his admission. His serum creatinine was 0. Diagnostic criteria for infertility included: history, physical examination, abdominal and transrectal ultrasonography, nuclear magnetic resonance imaging, hormonal studies and semen analyses. The patient denied genitourinary symptoms or previous surgery. Physical examination did not reveal testicular abnormalities. Abdominal ultrasonography, however, showed multiple large cysts in both kidneys and the liver. Transrectal ultrasonography revealed a normal prostate, but both seminal vesicles appeared enlarged, with diameters of 2 and 3.
JIMD Rep ; 38 Oxford University Press is a department of the University of Oxford. Nephrol Dial Transplant. Giorgio Fuiano.