Male Infertility in Renal Failure and Transplantation

Scott D. Lundy; Sarah C. Vij

Disclosures

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

In This Article

Paternity Following Renal Transplantation

Spontaneous Pregnancy Outcomes

Successful paternity during dialysis is challenging, with spontaneous pregnancy rates being decreased by at least 50% and possibly even more.[45] Despite the physiologic challenges associated with ESRD and renal transplantation, paternity rates appear to improve significantly following transplant. One large study identified over 200 successful spontaneous pregnancies following renal transplant in the male partner.[33] The pregnancies occurred between 1 to 16 years after transplant, and the data suggested that partners who conceive within 2 years of transplant are at risk for modestly decreased birth weights and premature delivery, which occurred in 15% of patients in this cohort.[33] This study, however, unfortunately did not provide the incidence of pregnancy or the total number of male transplants during the study period, and thus the actual paternity rate cannot be calculated. Another fascinating population-based retrospective study examined almost 500 children fathered by recipients of solid organ transplants. The majority of men were on a triple immunosuppression regimen including steroids, tacrolimus/cyclosporine, and mycophenolate/azathioprine. Compared to children fathered by this same group prior to transplant, the rates of major malformations and preterm delivery were not significantly different. Surprisingly, however, the odds ratio for developing preeclampsia was 7.4, suggesting a strong linkage between male immunosuppression and this condition.[46] While the mechanism underlying this effect and preeclampsia in general is not fully elucidated, the data is tantalizing and suggests that further studies are necessary.

Assisted Reproduction

Despite the improvement in semen parameters seen in most patients, some men will persistently demonstrate oligoasthenozoospermia following transplant. If unable to conceive naturally, these men may benefit from additional workup and management including the use of intracytoplasmic sperm injection (ICSI). Two small case series have demonstrated feasibility for this approach. The first showed successful paternity in 2 women whose partners had prior kidney transplants without subsequent recovery in fertility;[47] unfortunately the third couple in this report were unable to sustain a pregnancy despite transfer of multiple embryos. The second report described 8 couples who pursued ICSI with resulting successful pregnancies in 4 couples and live births in 3.[48] In addition to these early reports, successful ICSI has been reported in a variety of unique male transplant recipient patient populations including cystinosis,[49] hyperoxaluria with cryptorchidism,[50] and oligospermic renal transplant male recipient with female liver transplant recipient.[51] Taken together, this body of literature suggests that ART is a viable option for couples with male infertility following renal transplant, albeit with mixed success.

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