Saudi Journal of Kidney Diseases and Transplantation

ORIGINAL ARTICLE
Year
: 2007  |  Volume : 18  |  Issue : 3  |  Page : 387--390

Infertility among Female Renal Transplant Recipients


S Ghazizadeh, M Lessan-Pezeshki, MR Khatami, M Mahdavi-Mazdeh, MR Abbasi, J Azmandian, E Razeghi, S Seifi, F Ahmadi, S Maziar 
 Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran

Correspondence Address:
S Ghazizadeh
Ob/Gyn Department,Imam Khomeini Medical Center, Tehran University of Medical Sciences Keshavarz Blvd., Tehran
Iran

Abstract

We studied 122 women with renal allograft transplantation to evaluate their reproductive systems. The patients were recruited from the three main kidney transplant surgery centers in Tehran, from September to October 2005. Fifteen (12%) patients were either in the menopausal stage or had hysterectomies, and the other 33(27%) were unmarried. Of the 76(62%) married women at the reproductive age, 10 (13.1%) had infertility that was defined as the failure of a married woman to conceive after 12 months of frequent intercourse without contraception. Three patients had male factor infertility, three others had ovulatory problems, and four cases were undefined. Only six cases were actively treated by ovulation induction ± an intrauterine inducer (IUI); two patients became pregnant, while the other four refused infertility treatment. The reasons of unwillingness for infertility treatment included old age (40 years) in one patient, positive HBsAg in one, renal retransplantation in one, and previous clomiphene therapy failure in another. We conclude that the prevalence of infertility among female renal transplant recipients is the same as the general population, and the causes are mostly treatable. However, many are less motivated to be treated for this problem.



How to cite this article:
Ghazizadeh S, Lessan-Pezeshki M, Khatami M R, Mahdavi-Mazdeh M, Abbasi M R, Azmandian J, Razeghi E, Seifi S, Ahmadi F, Maziar S. Infertility among Female Renal Transplant Recipients.Saudi J Kidney Dis Transpl 2007;18:387-390


How to cite this URL:
Ghazizadeh S, Lessan-Pezeshki M, Khatami M R, Mahdavi-Mazdeh M, Abbasi M R, Azmandian J, Razeghi E, Seifi S, Ahmadi F, Maziar S. Infertility among Female Renal Transplant Recipients. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2022 Jul 2 ];18:387-390
Available from: https://www.sjkdt.org/text.asp?2007/18/3/387/33757


Full Text

 Introduction



Renal insufficiency is generally accom­panied by impaired reproductive function, particularly in females. Women with chronic renal failure frequently suffer from loss of libido, anovulatory vaginal bleeding, ame­norrhea, and high prolactin levels. [1]

Fertility is usually restored in women with renal transplantation and full term pregnancy is common with an incidence of 12% of women at the childbearing age. [2] The recovery of fertility is less common in women who undergo transplantation close to the end of their childbearing age. [3] The first reported successful pregnancy occurred in a recipient of a kidney transplant from an identical twin sister performed in 1958. [4] Since then, there have been hundreds of successful pregnancies reported in renal transplant recipients. [5] During the last decade, there was a steady increase in the number of pregnancies following renal transplantation. [6]

We conducted a cross sectional study in our center in order to evaluate the prevalence of infertility among our kidney transplant recipients and its outcome.

 Patients and Methods



We studied 122 women with transplanted kidneys with ages that ranged from 15-68 years; 97.7% of them received living renal allografts (11.8% related and 85.9% unrelated donors), while 2.4% received cadaver renal allografts. The patients were recruited from the three main kidney transplant surgery centers in Tehran, from September to October 2005. The principal investigator conducted interviews to collect data from the subjects using a semi­structured questionnaire that was constructed by the researcher. Infertility was defined as the failure of a couple to conceive after 12 months of frequent intercourse without contraception. [7]

 Results



We studied 122 women with renal allograft transplantation to evaluate their reproductive systems. Fifteen (12%) patients were either in the menopausal stage or had hysterectomies, and the other 33 (27%) were unmarried. Among the 76 (62%) married women at the reproductive age, 10 (13.1%) had infertility. However, only 60% sought medical advise for the treatment of infertility, and 33.3% of them became pregnant.

Three patients had male factor infertility, three others had ovulatory problems, and four cases were undefined. Only six cases were actively treated by ovulation induction ± an intrauterine inducer (IUI); two patients became pregnant, while the other four refused inferti­lity treatment. The reasons of unwilling-ness for infertility treatment included old age (40 years) in one patient, positive HBsAg in one, and renal retransplantation in one, and previous clomiphene therapy failure in one.

 Discussion



Most female transplant recipients are unaware that transplantation may reverse the relative infertility associated with end-stage renal disease. The incidence of unwanted pregnancy among female kidney transplant recipients is significantly higher than in the general population. [8] An unplanned conception imposes increased risk to the transplanted women; either an induced abortion or conti­nued pregnancy without a preconception evaluation could be harmful. [9] The outcomes for unwanted pregnancies are inferior to the outcomes for planned pregnancies, so it is strongly advised that every sexually active transplant recipient should attend a family­planning counseling session.

Women are usually advised to wait at least one year after living related donor transplanta­tion and two years after cadaver transplanta­tion. However, waiting five or more years may result in progressively impaired renal function post-partum due to the usually prevalent chronic allograft nephropathy. [10] It is recommended that renal transplant recipients who wish to conceive meet a number of health criteria [Table 1].

We demonstrated in our study that infertility among kidney transplant recipients has probably the same prevalence as that in the general population; however, only 60% sought treatment, and 33.3% of them became pregnant.

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

The treatment of infertility can be successful in the transplant population. Case et al. presented a case of a successful twin pregnancy resulting from in-vitro fertilization with intra­cytoplasmic sperm injection (IVF/ICSI) in a liver transplant recipient, whose partner was a renal transplant recipient with severe oligos­permia. [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]

Sexual function improves in general in male and female transplant recipients. Schover studied sexual function and fertility of 54 men and 36 women, at an average of three years after successful renal transplant. [14] Sexual desire increased significantly compared to the levels of six months pre transplant. Men also had improved erectile function and ability to reach coital orgasms. However, about a quarter of men and women remained sexually dys­functional, the frequency of sexual activity and overall sexual satisfaction did not improve significantly.

We conclude from this study that while renal transplant females plan to conceive, they should consult obstetricians and trans­plant physicians. The incidence of infertility among kidney transplant recipients is the same as the general population, and the causes are mostly treatable. However, many patients are not motivated to be treated for this problem.

References

1Zingraff J, Jungers P, Pelissier C, et al. Pituitary and ovarian dysfunction in women on haemodialysis. Nephron 1982;30:149-53.
2Sturgiss SN, Davison JM. Effect of pregnancy on long term function of renal allograft. Am J Kidney Dis 1992;19(2):167-72.
3Hou S. Pregnancy in chronic renal insufficiency and end stage renal disease. Am J Kidney Dis 1999; 33:235-52.
4Murray J, Reid DE, Harrison JH, et al. Successful pregnancies after human renal transplantation. N Engl J Med 1963;269:341-3.
5Davison JM. Renal transplantation and pregnancy. Am J Kidney Dis 1987;9:374-80.
6Sgro MD, Barozzino T, Mirghani HM, et al. Pregnancy outcome post renal transplantation. Teratology 2002;65:5-9.
7Speroff L, Darney P. A Clinical Guide for Contraception, Lippincott, Williams & Wilkins, 2001.
8Ghazizadeh S, Lessan-Pezeshki M, Khatami MR, Mahdavi M. Unwanted pregnancy in kidney transplant recipients in Iran. Transplant Proc 2005;37(7):3085-6.
9Lessan-Pezeshki M, Ghazizadeh S, Khatami MR, et al. Fertility and contraceptive issues after kidney transplantation in women. Transplant proc 2004;36:1405-6.
10Lessan-Pezeshki M. Pregnancy after renal transplantation: points to consider. Nephrol Dial Transplant 2002;17:703-7.
11Kaczmarek I, Groetzner J, Adamidis I, Landwehr P. Sirolimus impairs gonadal function in heart transplant recipients. Am J Transplant 2004;4(7): 1084-8.
12Case AM, Weissman A, Sermer M, Greenblatt EM. Successful twin pregnancy in a dual-transplant couple resulting from in-vitro fertilization and intracytoplasmic sperm injection. Hum Reprod 2000;15(3):626-8.
13Lockwood GM, Ledger WL, Barlow DH. Successful pregnancy outcome in a renal transplant patient following in­vitro fertilization. Hum Reprod 1995; 10(6):1528-30.
14Schover 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.