MALE INFERTILITY IN RENAL FAILURE AND TRANSPLANTATION: A COMPARATIVE STUDY

Abstract

Background

Male infertility is a significant but often underrecognized problem in patients with chronic kidney disease and end-stage renal failure. Uremia, hormonal imbalance, erectile dysfunction, impaired spermatogenesis, and the effects of long-term systemic illness can adversely affect reproductive potential. Kidney transplantation may improve endocrine and sexual function; however, fertility impairment may persist in some patients.

Objectives

To compare fertility-related clinical, hormonal, and semen parameters in men with renal failure and post-renal transplantation patients and to determine the impact of transplantation on reproductive outcomes.

Methodology

This retrospective comparative study was conducted at department of andrology & nephrology Institute of kidney disease Peshawar from jan 2023 to jan 2024. A total of 100 patients were included, comprising 50 men with end-stage renal failure on dialysis and 50 male renal transplant recipients. Demographic characteristics, duration of renal disease, duration of dialysis or transplantation, erectile dysfunction, serum testosterone, luteinizing hormone, follicle-stimulating hormone, prolactin, semen parameters, and fertility outcomes were recorded using a structured data collection form. Data were analyzed using SPSS version 24. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Statistical significance was set at p < 0.05.

Results

A total of 100 patients were included in the study. The mean age of the patients was 36.8 ± 7.4 years. Erectile dysfunction was more common in the renal failure group than in the transplant group (54% vs 28%). Mean serum testosterone was significantly lower in patients with renal failure compared with transplant recipients (2.9 ± 1.1 ng/mL vs 4.6 ± 1.3 ng/mL, p = 0.01), while prolactin levels were higher in the renal failure group. Abnormal semen analysis was observed in 72% of patients with renal failure and 46% of post-transplant patients. Oligospermia and reduced motility were the most frequent abnormalities. Spontaneous conception or documented paternity was more common after transplantation than during renal failure follow-up. Overall, renal transplant recipients demonstrated better hormonal and fertility profiles than men with ongoing renal failure.

Conclusion

Male infertility is common in patients with renal failure and is associated with hormonal imbalance, erectile dysfunction, and abnormal semen parameters. Renal transplantation appears to improve reproductive hormonal status and semen quality in many patients, although fertility impairment may persist in a subset. Early fertility counseling and multidisciplinary management are important in these patients.