Delesalle A-S, Robin G, Provôt F, Dewailly D, Leroy-Billiard M, Peigné M
Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
Service de gynécologie endocrinienne et médecine de la reproduction, hôpital Jeanne-de-Flandres, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
Gynecol Obstet Fertil. 2015 Jan;43(1):33-40. doi: 10.1016/j.gyobfe.2014.11.013. Epub 2014 Dec 17.
Chronic renal failure leads to many metabolic disorders affecting reproductive function. For men, hypergonadotropic hypogonadism, hyperprolactinemia, spermatic alterations, decreased libido and erectile dysfunction are described. Kidney transplantation improves sperm parameters and hormonal function within 2 years. But sperm alterations may persist with the use of immunosuppressive drugs. In women, hypothalamic-pituitary-ovarian axis dysfunction due to chronic renal failure results in menstrual irregularities, anovulation and infertility. After kidney transplantation, regular menstruations usually start 1 to 12 months after transplantation. Fertility can be restored but luteal insufficiency can persist. Moreover, 4 to 20% of women with renal transplantation suffer from premature ovarian failure syndrome. In some cases, assisted reproductive technologies can be required and imply risks of ovarian hyperstimulation syndrome and must be performed with caution. Pregnancy risks for mother, fetus and transplant are added to assisted reproductive technologies ones. Only 7 authors have described assisted reproductive technologies for patients with kidney transplantation. No cases of haemodialysis patients have been described yet. So, assisted reproductive technologies management requires a multidisciplinary approach with obstetrics, nephrology and reproductive medicine teams' agreement.
慢性肾衰竭会导致许多影响生殖功能的代谢紊乱。对于男性，会出现高促性腺激素性性腺功能减退、高催乳素血症、精子改变、性欲减退和勃起功能障碍。肾移植可在2年内改善精子参数和激素功能。但使用免疫抑制药物时精子改变可能持续存在。对于女性，慢性肾衰竭导致的下丘脑 - 垂体 - 卵巢轴功能障碍会引起月经不调、无排卵和不孕。肾移植后，月经通常在移植后1至12个月恢复正常。生育能力可以恢复，但黄体功能不全可能持续存在。此外，4%至20%的肾移植女性患有卵巢早衰综合征。在某些情况下，可能需要辅助生殖技术，这意味着存在卵巢过度刺激综合征的风险，必须谨慎进行。辅助生殖技术还会增加母亲、胎儿和移植肾的妊娠风险。只有7位作者描述过针对肾移植患者的辅助生殖技术。尚未有血液透析患者的相关病例报道。因此，辅助生殖技术的管理需要多学科方法，需产科、肾病科和生殖医学团队达成共识。
