MALE REPRODUCTIVE FUNCTION IN UREMIA - EFFICACY OF HEMODIALYSIS AND RENAL-TRANSPLANTATION

Objective To evaluate the impact of maintenance haemodialysis and live -related renal transplantation on the reproductive potential of men wi th end-stage renal disease. Patients and methods The plasma levels of testosterone, follicle-stimulating hormone (FSH) and luteinizing hormo ne (LH) were determined, and semen analysed, in 19 men (22-41 years ol d) with advanced uraemia after 6 months of dialysis and again 6 months after renal transplantation. Eight patients who had azoospermia or se vere oligospermia underwent testicular biopsy after 6 months of dialys is 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 patient s 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, te stosterone and LH levels returned to normal in 15 and 13 patients, res pectively, while FSH levels became normal in only two patients. The re covery of testosterone and LH levels after transplantation was statist ically significant. Semen quality improved in 13 patients, with the im provement in sperm density and motility being statistically significan t. Testicular histology revealed normal spermatogenesis in four patien ts, while three continued to show late-maturation arrest. The wives of five of the transplanted patients conceived. Conclusions The impairme nt of testicular function seen in advanced uraemia is not reversible b y maintenance haemodialysis. In contrast, after successful transplanta tion, steroidogenic function became almost normal while spermatogenic function showed a striking if incomplete recovery.