• Figure 1.

    Infertility risk factors and considerations in males with CKD

  • 1.

    Agarwal A, et al. A unique view on male infertility around the globe. Reprod Biol Endocrinol 2015; 13:37. doi: 10.1186/s12958-015-0032-1

  • 2.

    Gnoth C, et al. Time to pregnancy: Results of the German prospective study and impact on the management of infertility. Hum Reprod 2003; 18:19591966. doi: 10.1093/humrep/deg366

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Lehtihet M, Hylander B. Semen quality in men with chronic kidney disease and its correlation with chronic kidney disease stages. Andrologia 2015; 47:11031108. doi: 10.1111/and.12388

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Lundy SD, Vij SC. Male infertility in renal failure and transplantation. Transl Androl Urol 2019; 8:173181. doi: 10.21037/tau.2018.07.16

  • 5.

    Niederberger CS, et al. Male infertility. In Campbell-Walsh-Wein Urology, 12th Edition. Partin AW, et al., eds. Elsevier, 2020:1428-1452.

  • 6.

    Xu L-G, et al. Examination of the semen quality of patients with uraemia and renal transplant recipients in comparison with a control group. Andrologia 2009; 41:235240. doi: 10.1111/j.1439-0272.2009.00924.x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Shamsa A, et al. Erectile function in end-stage renal disease before and after renal transplantation. Transplant Proc 2005; 37:30873089. doi: 10.1016/j.transproceed.2005.08.067

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Xu LG, et al. Characteristics of male fertility after renal transplantation. Andrologia 2011; 43:203207. doi: 10.1111/j.1439-0272.2010.01052.x

  • 9.

    Berkkanoglu M, et al. Intracytoplasmic sperm injection in male renal transplant recipients. Middle East Fertil Soc J 2015; 20:127130. https://www.sciencedirect.com/science/article/pii/S1110569014200082

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    • Search Google Scholar
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Chronic Kidney Disease and Male Factor Infertility

Engy Habashy Engy Habashy, MD, is a board-eligible urologist at the Veterans Health Administration in Columbus, OH. She is fellowship-trained in male infertility.

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Infertility is defined as the inability to conceive after 12 months of timed intercourse. Infertility is a common problem, affecting approximately 10%-15% of couples trying to conceive. Male factor infertility accounts for up to 50% of all cases (1). In a well-conducted study of 346 couples attempting to conceive, cumulative pregnancy rates were 38%, 68%, 81%, and 92% at 1, 3, 6, and 12 months, respectively (2). Therefore, it is reasonable to initiate an evaluation after 6-12 months of an inability to conceive. The successful production and expulsion of male gametes require the intricate function of multiple organ systems. Thus, it is unsurprising that many disease processes can negatively impact male reproductive health. Although much attention has been focused on the impact of chronic kidney disease (CKD) on female reproductive health, male reproductive health can also be negatively impacted.

The correlation between CKD and subfertility has been well-established in the literature. Males with CKD have higher incidence of sexual dysfunction, loss of libido, arteriosclerosis, endocrinopathies, impaired spermatogenesis, neuropathy, hypertension, and polypharmacy (Figure 1). A study of 66 males with different stages of kidney diseases revealed a significant decrease in testosterone correlating with the degree of kidney function loss. Luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin also showed a tendency to increase. The same study also revealed negative linear correlation between CKD stage and sperm concentration, motility, tail morphology defects, and total motile sperm counts (3), each of which contributes to infertility. Worsening kidney function is thought to impact male reproductive health by causing accumulation of uremic metabolites in the testes, thereby negatively affecting Sertoli and Leydig cells' function and contributing to inflammation and fibrosis of the seminiferous tubules (4).

Figure 1.
Figure 1.

Infertility risk factors and considerations in males with CKD

Citation: Kidney News 15, 8

TSH, thyroid-stimulating hormone.

Diabetes mellitus and medication side effects are additional elements that exist to a greater extent in the CKD population than in the general population and have adverse effects on male reproductive health. The negative impact of antihypertensive agents on erectile function is well established. The impact of these agents on male reproductive potential is less clear. Investigators proposed that calcium channel blockers can impair fertilization, whereas angiotensin-converting enzyme inhibitors appear to improve sperm motility (5).

In patients with kidney failure, studies demonstrated a correlation between the duration of hemodialysis and the decline in sperm quality and testicular volume. Kidney transplantation has been shown to restore spermatogenesis and the reproductive hormonal axis in some but not all patients with kidney transplants (6). In parallel, with improvement in semen and hormonal parameters, kidney transplantation may also contribute to improvement in erectile function (7). Xu et al. (8) assessed spontaneous pregnancy rates after kidney transplant and noted an increase in birth weight and a decrease in prematurity rate, 24 months after the male partner's kidney transplant. In patients who continue to suffer from poor semen parameters after transplant, studies show moderate success rates with assisted reproductive technology/intracytoplasmic sperm injection (9).

In summary, males with CKD are at an increased risk of subfertility. Nephrologists and urologists often collaborate in caring for patients with various urinary pathologies (stones, congenital kidney disease, or anatomic abnormalities). Male factor infertility in men with CKD is another opportunity where the close collaboration between nephrologists and reproductive urologists can greatly impact the quality of patients' lives. As one would expect, with couples facing infertility challenges, the evaluation of the female partner by a reproductive specialist is paramount.

Footnotes

The author reports no conflicts of interest.

References

  • 1.

    Agarwal A, et al. A unique view on male infertility around the globe. Reprod Biol Endocrinol 2015; 13:37. doi: 10.1186/s12958-015-0032-1

  • 2.

    Gnoth C, et al. Time to pregnancy: Results of the German prospective study and impact on the management of infertility. Hum Reprod 2003; 18:19591966. doi: 10.1093/humrep/deg366

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Lehtihet M, Hylander B. Semen quality in men with chronic kidney disease and its correlation with chronic kidney disease stages. Andrologia 2015; 47:11031108. doi: 10.1111/and.12388

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Lundy SD, Vij SC. Male infertility in renal failure and transplantation. Transl Androl Urol 2019; 8:173181. doi: 10.21037/tau.2018.07.16

  • 5.

    Niederberger CS, et al. Male infertility. In Campbell-Walsh-Wein Urology, 12th Edition. Partin AW, et al., eds. Elsevier, 2020:1428-1452.

  • 6.

    Xu L-G, et al. Examination of the semen quality of patients with uraemia and renal transplant recipients in comparison with a control group. Andrologia 2009; 41:235240. doi: 10.1111/j.1439-0272.2009.00924.x

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Shamsa A, et al. Erectile function in end-stage renal disease before and after renal transplantation. Transplant Proc 2005; 37:30873089. doi: 10.1016/j.transproceed.2005.08.067

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Xu LG, et al. Characteristics of male fertility after renal transplantation. Andrologia 2011; 43:203207. doi: 10.1111/j.1439-0272.2010.01052.x

  • 9.

    Berkkanoglu M, et al. Intracytoplasmic sperm injection in male renal transplant recipients. Middle East Fertil Soc J 2015; 20:127130. https://www.sciencedirect.com/science/article/pii/S1110569014200082

    • PubMed
    • Search Google Scholar
    • Export Citation
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