Male reproductive function in uraemia: efficacy of haemodialysis and renal transplantation

Abstract

Objective To evaluate the impact of maintenance haemodialysis and live‐related renal transplantation on the reproductive potential of men with end‐stage renal disease. Patients and methods The plasma levels of testosterone, follicle‐stimulating hormone (FSH) and luteinizing hormone (LH) were determined, and semen analysed, in 19 men (22–41 years old) with advanced uraemia after 6 months of dialysis and again 6 months after renal transplantation. Eight patients who had azoospermia or severe oligospermia underwent testicular biopsy after 6 months of dialysis and again 6 months after the transplant. Results Following dialysis, levels of testosterone were low in 17 patients and levels of LH and FSH were elevated in 15 and eight patients, respectively. Four patients each had azoospermia and severe oligospermia. The testicular tissue was hypospermatogenic in three patients, showed late‐maturation arrest in four and germ cell aplasia in one. After renal transplantation, testosterone and LH levels returned to normal in 15 and 13 patients, respectively, while FSH levels became normal in only two patients. The recovery of testosterone and LH levels after transplantation was statistically significant. Semen quality improved in 13 patients, with the improvement in sperm density and motility being statistically significant. Testicular histology revealed normal spermatogenesis in four patients, while three continued to show late‐maturation arrest. The wives of five of the transplanted patients conceived. Conclusions The impairment of testicular function seen in advanced uraemia is not reversible by maintenance haemodialysis. In contrast, after successful transplantation, steroidogenic function became almost normal while spermatogenic function showed a striking if incomplete recovery.

Gonadal dysfunction in systemic diseases

“…A decreased volume of ejaculate combined with low or complete azoospermia and a low percentage of motility has been shown in semen analysis (32). Compared with other causes of severe primary testicular lesions, the Leydig and Sertoli cells show little evidence of hypertrophy or hyperplasia, probably due to a defect in their hormonal regulation.…”

“…The plasma FSH levels tend to be highest in those uremic patients with the most severe damage to seminiferous tubules and presumably the lowest levels of inhibin. It has been reported that high FSH levels may portend a poor prognosis for recovery of spermatogenic function after renal transplantation (32). The administration of clomiphene to uremic patients leads to an appropriate rise in the levels of both LH and FSH, suggesting that the negative feedback control on the hypothalamus is intact and that the storage and release of gonadotropins by the pituitary is normal (34).…”

Erectile dysfunction in chronic kidney disease: From pathophysiology to management

“…The plasma concentration of the pituitary gonadotropin luteinizing hormone (LH) is elevated probably as a result of the decreased release of testosterone from the Leydig cells and the consequent loss of normal negative feedback. In addition the metabolic clearance rate of LH is reduced and it is not corrected by dialysis [16] . In uremic subjects disturbances in LH secretion has been observed but it is not known whether this is the result of a change in GnRH release from the hypothalamus or a change in the responsiveness of the pituitary.…”

Expression of vascular endothelial growth factor and transforming growth factor alpha in rat testis during chronic renal failure

“…Chronic renal failure (CRF) is associated with impaired spermatogenesis and testicular damage, often leading to infertility. A decreased volume of ejaculate combined with low or complete azoospermia and a low percentage of motility has been shown in semen analysis [27]. Leydig and Sertoli cells are prone to defects in their hormonal regulation.…”

“…The exact pathophysiological mechanism involved in CRF-induced testicular damage is not fully understood. Haemodialysis patients have reduced testicular volume, indicating impaired spermatogenesis [41], however, recovery of hormonal and spermatogenic abnormalities occur after renal transplantation [27,39]. Spermatozoa obtained from uremic patients show improved ultrastructural features after renal transplantation, and a low dose of immunosuppressant is suggested to prevent degenerating effects of immunosuppressive therapy on seminiferous epithelia [42].…”