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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2007  |  Volume : 18  |  Issue : 1  |  Page : 79-82
Infertility among Kidney Transplant Recipients

1 Tehran University of Medical Sciences, Tehran, Iran
2 Imam Khomeini Medical Center, Iran

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We studied 122 women with a transplanted kidney to evaluate their reproductive performance. 15 of the patients were either post-menopausal or underwent hysterectomy and 33 were unmarried. Of the 76 married reproductive age women, 10 (13.1%) were infertile. Three had male factor infertility, three had ovulatory problems and in four cases, the cause was uncertain. Six of these patients were actively treated by ovulation induction with or without IUI and two of these patients became pregnant. The remaining four patients refused treatment for infertility. We conclude that the incidence of infertility among kidney transplant recipients is similar to the general population, but they are less motivated to be treated for infertility.

Keywords: Infertility, Kidney Transplantation, Pregnancy

How to cite this article:
Ghazizadeh S, Lessan-Pezeshki M, Khatami MR, Mahdavi-Mazdeh M, Abbasi MR, Azmandian J, Razeghi E, Seifi S, Ahmadi F, Maziar S. Infertility among Kidney Transplant Recipients. Saudi J Kidney Dis Transpl 2007;18:79-82

How to cite this URL:
Ghazizadeh S, Lessan-Pezeshki M, Khatami MR, Mahdavi-Mazdeh M, Abbasi MR, Azmandian J, Razeghi E, Seifi S, Ahmadi F, Maziar S. Infertility among Kidney Transplant Recipients. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2022 Jan 18];18:79-82. Available from: https://www.sjkdt.org/text.asp?2007/18/1/79/31850

   Introduction Top

Renal insufficiency is generally accom­panied by impaired reproductive function, particularly among females. Women with chronic renal failure frequently suffer from decreased libido, anovulatory vaginal bleeding or amenorrhea and high prolactin levels.[1] Fertility is usually restored in women after renal transplantation and pregnancy is not uncommon and has been observed in 12% of women of childbearing age in one series.[2] The rate of successful pregnancies exceeds 90% after the first trimester.

Recovery of fertility is less common in women who undergo transplantation close to the end of their childbearing age.[3] The first successful pregnancy in a kidney transplant recipient was reported in 1958; the donor was an identical twin sister. [4] Since then, hundreds of successful pregnancies have been reported in renal transplant recipients. [5] During the last decade, there has been a steady increase in the number of pregnancies reported among renal transplant recipients. [6]

To evaluate the prevalence and outcomes of infertility among a group of kidney transplant recipients, we conducted a cross sectional study in our center. Infertility was defined as the failure of a couple to conceive after 12 months of frequent intercourse without contraception. [7]

   Patients and Methods Top

The study group consisted of 122 women with a transplanted kidney with ages ranging from 15-68 years; 97.7% of them received their kidney from a living donor (11.8% related and 85.9% unrelated) and 2.4% had received a deceased kidney. Patients were recruited from the three main kidney transplant surgery centers in Tehran, between September and October 2005. The principal investigator conducted interviews to collect data from the subjects using a semi-structured questionnaire that was constructed by the researcher. The SPSS11.5 for Windows program was used for statistical analysis.

   Results Top

We studied 122 women with a transplanted kidney to evaluate their reproductive performance. Fifteen were either post­menopausal or underwent hysterectomy and 33 were unmarried. Among the 76 married women of reproductive age, 10 (13.1%) were diagnosed with infertility. Three had male factor infertility while three others had ovulatory problems and the cause was unclear in four cases. Six of these cases were actively treated by ovulation induction with or without IUI. Two of these patients became pregnant. The other four patients refused treatment for infertility; one because of old age (40 years), the second was HbsAg positive and had a relative contraindication to hormone use, the third received her second kidney graft and was unwilling to take any risk and the last individual experienced significant side effects of clomiphene during her first attempt.

   Discussion Top

Most female transplant recipients are unaware that transplantation can reverse the infertility associated with end-stage renal disease. The incidence of unwanted pregnancy among female kidney transplant recipients is significantly higher than in general popu­lation.[8] An unplanned pregnancy puts this special group at higher risk; either an induced abortion or continuing the pregnancy without proper prior evaluation could be harmful.[9] Outcomes for unwanted pregnancies are inferior to outcomes for planned pregnancies, so it is strongly advised that every sexually active transplant recipient attend a family­planning counseling session.

Women are usually advised to wait at least one year after living related donor transplantation and two years after cadaveric transplantation before planning pregnancy. However, waiting greater than five years may result in impaired renal function post-partum. This impairment may never be satisfactorily resolved because of the gradual deterioration of renal function secondary to chronic allograft nephropathy. [10] It is recommended that renal transplant recipients who wish to become pregnant meet a number of health criteria [Table - 1].

Kaczmarek et al. in their study demonstrated that heart transplant recipients treated with sirolimus revealed significantly lower free testosterone levels and significant increases in the gonadotropic hormones LH and FSH. [11]

Case et al. presented a case of successful twin pregnancy resulting from in-vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI) in a liver transplant recipient; her partner was a renal transplant recipient with severe oligozoospermia. [12]

Lockwood et al reported their experience of treating a couple with secondary infertility with in-vitro fertilization and embryo transfer. The wife was a renal transplant recipient.[13]

Schover studied sexual function and fertility of 54 men and 36 women, after an average of three years following successful renal transplantation.[14] Sexual desires increased significantly compared to the levels at six months prior to transplantation. Men also had improved erectile function and ability to reach non-coital orgasms. About a quarter of men and women remained sexually dysfunctional, however, the frequency of sexual activity and overall sexual satisfaction did not improve significantly.

   Conclusion Top

Before any female renal transplant recipient desires to become pregnant, an obstetrician and a transplant physician should counsel her. The incidence of infertility among kidney transplant recipients is similar to the general population, but these patients are, often times, less motivated to seek treatment for this problem.

   References Top

1.Zingraff J, Jungers P, Pelissier C, et al. Pituitary and ovarian dysfunctions in women on haemodialysis. Nephron 1982; 30:149-53.  Back to cited text no. 1  [PUBMED]  
2.Sturgiss SN, Davison JM. Effect of pregnancy on the long term function of renal allograft. Am J Kidney Dis 1992;19(2):167-72.  Back to cited text no. 2    
3.Hou S. Pregnancy in chronic renal insufficiency and end stage renal disease. Am J Kidney Dis 1999; 33:235-52.  Back to cited text no. 3  [PUBMED]  
4.Murray JE, Reid, DE, Harrison, JH, Merrill JP. Successful pregnancies after human renal transplantation. N Engl J Med1963;269:341-3.  Back to cited text no. 4    
5.Davison JM. Renal transplantation and pregnancy. Am J Kidney Dis 1987; 9:374-8.  Back to cited text no. 5  [PUBMED]  
6.Sgro MD, Barozzino T, Mirghani HM, et al. Pregnancy outcome post renal transplantation. Teratology 2002;65:5-9.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Speroff L, Darney P. A Clinical Guide for Contraception, Lippincott, Williams & Wilkins, 2001.  Back to cited text no. 7    
8.Ghazizadeh S, Lessan-Pezeshki M, Khatami MR, Mahdavi M. Unwanted pregnancy in kidney transplant recipients in Iran. Transplant Proc 2005;37(7):3085-6.  Back to cited text no. 8    
9.Lessan-Pezeshki M, Ghazizadeh S, Khatami MR, et al. Fertility and contraceptive issues after kidney transplantation in women. Transplant proc 2004;( 36):1405-6.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Lessan-pezeshki M. Pregnancy after renal transplantation: points to consider. Nephrol Dial Transplant 2002;17:703-7.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Kaczmarek I, Groetzner J, Adamidis I, et al. Sirolimus impairs gonadal function in heart transplant recipients. Am J Transplant 2004;4(7):1084-8.  Back to cited text no. 11    
12.Case AM, Weissman A, Sermer M, Greenblatt EM. Successful twin pregnancy in a dual-transplant couple resulting from in-vitro fertilization and intracytoplasmic sperm injection: case report. Hum Reprod 2000; 15(3):626-8.  Back to cited text no. 12    
13.Lockwood GM, Ledger WL, Barlow DH. Successful pregnancy outcome in a renal transplant patient following in-vitro fertilization. Hum Reprod 1995; 10(6):1528-30.  Back to cited text no. 13    
14.Schover LR, Novick AC, Steinmuller DR, Goormastic M. Sexuality, fertility and renal transplantation: a survey of survivors. J Sex Marital Ther 1990;16(1):3-13.  Back to cited text no. 14    

Correspondence Address:
Shirin Ghazizadeh
Imam Khomeini Medical Center, Keshavarz Blvd., Tehran
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PMID: 17237896

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