Sexual and Reproductive Function in Chronic Kidney Disease and Effect of Kidney Transplantation

Chronic renal failure has been known to be associated with impotence and loss of libido in men and for many women, infertility and menstrual irregularities. There have been ongoing improvements in survival and quality of life after renal transplantation. These have been accompanied by an improvement in reproductive function and reversal of the relative infertility that occurs despite maintenance hemodialysis. One of the most impressive aspects of successful renal transplantation in the young person is the ability of the male patient to father a child and the female patient to give birth to a healthy baby. Pregnancy does not appear to have any adverse effect on the long-term survival of renal allografts. Because the outcome of pregnancy in transplantation are so different than those in chronic dialysis, it is advisable to treat end-stage renal disease patients with transplantation and wait until renal function has been stable before undertaking a planned pregnancy. Women are usually advised to wait at least 1 year after living-related kidney Transplantation, and 2 years after cadaveric kidney transplantation; however, waits of 5 years or more have been associated with impaired renal function post-partum. All women of child-bearing age should be counseled about the possibility and risks of pregnancy after kidney transplantation. Types of immunosuppressive regimens and assessment of graft function should be considered during preconception counseling. Contraceptive counseling should be provided before transplantation surgery, because ovulatory cycles may begin within 1 to 2 months after transplantation in women with grafts that are functioning well. It is strongly advised that every sexually active transplant recipient attend a family-planning counseling session, ideally before transplantation is performed. Breastfeeding is discouraged for patients taking any immunosuppressive drugs. In this chapter we will first have a short review on reproductive physiology in male and female and irregularities caused by end stage renal disease and then we will review the experience of women undergoing child birth after transplantation, with a focus on outcomes and suggested management strategies including contraception counseling.