Among patient groups, those receiving liver and cardiac transplants often tend to be older individuals. As such, fertility issues are typically not frequent health concerns. However, those patients with end stage renal disease (ESRD) are often young when afflicted, and their primary disease process itself has been shown to directly impair fertility. For this reason, many of the items discussed below apply specifically to the ESRD/uremic population. Other items, duly noted, apply to the larger transplantation population as a whole.
The hypothalamic-pituitary-gonadal (HPG) axis is markedly disturbed by chronic renal failure, and this is manifest in diminished testosterone levels and impaired spermatogenesis. These patients often present with complaints of diminished libido, erectile dysfunction (ED), and infertility. Upon evaluation, they have low serum testosterone levels and elevated follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels.1 Interestingly, these patients usually retain a normal response to clomiphene citrate stimulation. Clomiphene citrate has antiestrogenic properties which result in a decrease in negative feedback by
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