Male Infertility in Renal Failure and Transplantation

Scott D. Lundy; Sarah C. Vij


Transl Androl Urol. 2019;8(2):173-181. 

In This Article

Abstract and Introduction


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.


With the rising prevalence of end stage renal disease (ESRD), over 100,000 Americans are now currently listed for kidney transplant. Approximately 13,000 patients received a deceased donor organ in 2016, and half of these recipients had been on dialysis for >5 years.[1] Men and women of childbearing age account for nearly 40% of the potential renal transplant recipients.[1] It is now well-established that both men and women with chronic kidney disease (CKD) have significant fertility and hormonal deficits associated with uremia, chronic inflammation, and changes in reproductive hormone levels. Taken together, the literature suggests that the paucity of donor organs and the prolonged wait time predisposes young adults with ESRD to a multitude of pathological reproductive changes associated with hemodialysis (HD).

Even without the complications associated with ESRD, approximately 15% of all couples worldwide experience infertility (defined as the inability to conceive after 12 months of timed intercourse). Roughly half of these cases can be attributed to male factors.[2] While the causes of male infertility have been well defined from an epidemiology perspective in the general population,[3] the ESRD population clearly represents a more challenging cohort. This is primarily due to the fact that male infertility in the dialysis population is multifactorial and often related to underlying comorbidities such as hypertension and diabetes, as well as specific changes associated with CKD and HD. In this brief review, we discuss the association of male infertility with CKD and dialysis. We explore the changes in reproductive hormones, semen quality, erectile dysfunction (ED), and paternity with renal transplantation.