Male Infertility in Renal Failure and Transplantation

Scott D. Lundy; Sarah C. Vij


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

In This Article

Adolescents and Renal Transplant

There is clear evidence that renal transplantation is the treatment of choice for young patients with ESRD from the perspectives of cost, quality of life, and mortality. Based upon the above literature, there is now increasing evidence that transplant also confers an improvement in male fertility before and during the window of fatherhood. The development of uremia during the critical window of childhood or puberty, however, appears to have profound and potentially irreversible effects on testicular health and semen quality even decades later. A recent study by Tainio and colleagues examined a small cohort of 24 male patients with ESRD secondary who underwent renal transplantation at an average of 10 years of age and compared them to healthy age-matched controls.[44] The group evaluated these young men for the next ~20 years and reported testicular size, endocrine function, and semen analyses. They found a striking 3-fold decrease in average testicular size compared to healthy male controls. This was accompanied by a lower testosterone level (322 vs. 399 pmol/L, respectively), higher LH (7.6 vs. 3.3 IU/L), and equivalent levels of FSH and inhibin B. Semen quality mirrored these changes. The transplant recipients demonstrated a 100-fold decrease in sperm count, with 28% of the patients demonstrating azoospermia. Of note, the majority of their cohort was on a cyclosporine-based regimen with or without mycophenolate. Taken together, this data suggests that either adolescent uremia or long-term immunosuppression (or both) provokes a significant and precipitous decline in male fertility. This group should be counseled accordingly and aggressively managed with urological consultation if paternity is desired.