Male Infertility in Renal Failure and Transplantation

Scott D. Lundy; Sarah C. Vij


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

In This Article


It is clear that ESRD exerts profound suppressive effects on male endocrine function, ED, spermatogenesis, resulting in significant reduction in conception rates for men with ESRD. While renal transplantation appears to reverse at least a portion of these changes, subfertility likely represents the rule rather than the exception in this population. The ongoing suppression in spermatogenesis and fertility is likely related to chronic structural changes in the testis, subtle residual perturbations in the HPG axis, and immunosuppression (though the latter still remains poorly studied, particularly with regards to modern regimens based upon tacrolimus). Ultimately, however, many of these men will successfully go on to father healthy offspring either through natural conception or with the assistance of ART. The reproductive outcomes appear to be worse for pediatric and adolescent transplant recipients—the explanation for this is multi-factorial as described above and is related to the underlying disease and its impact on the HPG axis and testis during puberty.

From humble beginnings with little clinical utility, the field of renal transplant has grown immensely in the past half-century and now represents the gold standard for improving the quality and quantity of life in young patients with renal failure. It is now time for the field to further refine this craft to improve secondary outcomes such as male infertility in order to maximize the urological care we as a field can offer our patients.