Cross-sectional studies of spermatogenesis, sperm output, and fertility in men with chronic renal failure have previously been reviewed (1,12). Successful renal transplantation reverses spermatogenic depression and infertility, as shown in short-term prospective and long-term retrospective studies. Even after successful transplantation, which restores testicular endocrine function, the degree of fertility recovery may be limited by irreversible damage to spermatogenesis accrued during prolonged dialysis (1,14). Spermatogenesis and fertility were examined prospectively in 19 young men during at least 6 mo of regular hemodialysis and subsequently at least 6 mo after successful transplantation (79). During regular hemodialysis, there were no pregnancies and all but two had subnormal sperm output with biopsy-proven hypospermatogenesis. After living-related renal transplantation, fertility and spermatogenesis improved markedly, with five wives conceiving, 13 men normalizing sperm density and motility, and 4 of 8 men, who underwent testicular biopsy before and after transplantation, normalizing spermatogenesis. Based on the hormonal evidence for partial gonadotropin deficiency (or resistance), further well-controlled clinical studies of gonadotropin therapy (estrogen blockade, hCG, FSH, and pulsatile GnRH) on spermatogenesis in men with chronic renal failure will be of considerable interest.
Androgen therapy for men with chronic renal failure to correct anemia or nutritional status involves risk of depressing endogenous testicular steroidogenesis and spermatogenesis (80). If fertility is desired, the appropriate management is to stop the exogenous androgen, which allows spermatogenesis to recover. If this is not feasible or is inadequate, hCG treatment may be useful but has not been formally evaluated. Any treatment to improve fertility can theoretically also be combined with testicular sperm extraction for intracytoplasmic sperm injection (ICSI) although the bleeding and infection risks of the large testicular biopsy required careful consideration.
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