Natural pregnancy following kidney transplantation in an azoospermic male: a case report.

IF 1.7 3区医学 Q4 ANDROLOGY

Translational andrology and urology Pub Date : 2025-07-30 Epub Date: 2025-07-25 DOI:10.21037/tau-2025-319

Ngoc Thai Nguyen, Huu Hoang Quan Nguyen, Teppei Takeshima, Shinnosuke Kuroda, Yasushi Yumura, Widi Atmoko, Huynh Dang Khoa Nguyen

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Abstract

Background: Chronic kidney disease (CKD) and its advanced form, end-stage kidney disease (ESKD), disrupt male reproductive capacity, largely due to endocrine disturbances and impaired sperm production. Kidney transplantation (KTx) may reverse these effects by normalizing kidney function and recalibrating the hypothalamic-pituitary-gonadal (HPG) axis. Here, we report the first known case of natural conception in a male with ESKD and non-obstructive azoospermia (NOA) after KTx.

Case description: A 32-year-old man experienced reduced sexual desire, mild erectile dysfunction, and infertility for four years. Workup revealed stage 3 CKD from chronic glomerulonephritis and hypertension, later advancing to ESKD, along with NOA confirmed by two semen analyses. Choosing KTx over prompt surgical sperm extraction, he achieved normalized renal function and partial endocrine recovery by 3 months post-transplant. Semen analysis confirmed restored sperm production, leading to a spontaneous pregnancy, which unfortunately ended in a miscarriage at 7 weeks.

Conclusions: This case underscores the possibility of fertility restoration in azoospermic men with ESKD after KTx. Despite challenges such as sperm quality issues and immunosuppressive drugs potentially affecting outcomes, KTx appears to enhance sexual function and sperm production, providing a promising fertility option for ESKD patients. Additional reports are essential to elucidate treatment strategies and the long-term impacts of immunosuppressive agents on male reproductive health.

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无精子男性肾移植后自然妊娠一例报告。

背景：慢性肾脏疾病（CKD）及其晚期形式，终末期肾脏疾病（ESKD），破坏男性生殖能力，主要是由于内分泌紊乱和精子产生受损。肾移植（KTx）可以通过使肾功能正常化和重新校准下丘脑-垂体-性腺（HPG）轴来逆转这些影响。在这里，我们报告了首例已知的男性ESKD和非阻塞性无精子症（NOA）在KTx后自然受孕的病例。病例描述：32岁男性，性欲减退，轻度勃起功能障碍，不孕四年。检查显示慢性肾小球肾炎和高血压引起的3期CKD，后来进展为ESKD，并伴有两次精液分析证实的NOA。在移植后3个月，患者的肾功能和部分内分泌恢复正常。精液分析证实恢复了精子生产，导致自然怀孕，不幸的是在7周时流产。结论：该病例强调了无精子男性ESKD患者在KTx后恢复生育能力的可能性。尽管存在精子质量问题和免疫抑制药物等潜在影响结果的挑战，但KTx似乎可以增强性功能和精子产生，为ESKD患者提供了一个有希望的生育选择。需要更多的报告来阐明治疗策略和免疫抑制剂对男性生殖健康的长期影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Translational andrology and urology Medicine-Urology

CiteScore

4.10

自引率

5.00%

发文量

期刊介绍： ranslational Andrology and Urology (Print ISSN 2223-4683; Online ISSN 2223-4691; Transl Androl Urol; TAU) is an open access, peer-reviewed, bi-monthly journal (quarterly published from Mar.2012 - Dec. 2014). The main focus of the journal is to describe new findings in the field of translational research of Andrology and Urology, provides current and practical information on basic research and clinical investigations of Andrology and Urology. Specific areas of interest include, but not limited to, molecular study, pathology, biology and technical advances related to andrology and urology. Topics cover range from evaluation, prevention, diagnosis, therapy, prognosis, rehabilitation and future challenges to urology and andrology. Contributions pertinent to urology and andrology are also included from related fields such as public health, basic sciences, education, sociology, and nursing.