Having a child is a joy but conceiving or carrying a baby to term can be a challenge if you have medical problems. A question that likely crosses the mind of many patients of reproductive age, male or female is – “will i be able to have children?”. The good news is that many of the causes of reduced reproductive capability in patients with kidney disease are known and can be treated by carefully following the instructions of knowledgeable specialists in kidney disease and reproduction.
This post will aim to address the background behind reproductive potential of patients with kidney disease and answer questions of relevance to patients with either advanced kidney disease, those undergoing dialysis treatment or those who have a kidney transplant. The information in this post is NOT a substitute for close consultation with a kidney specialist and readers are advised to seek the counsel of such experts to address their care and concerns.
Advanced kidney disease affects reproductive potential of both males and females and directly can impact the outcome of pregnancy.
In male patients with advanced kidney disease or on dialysis, problems with getting a sufficient erection, decreased sexual desire and decreased sperm count are common problems that make conception difficult. This is often due to low levels of male sex hormone called testosterone- a direct consequence of kidney disease. Getting close follow up with a doctor, getting anemia and hypertension treated properly and getting enough dialysis if necessary at least 3 times a week is key to addressing many of these problems.
Problems with erection and ejaculation however can occur in patients even without kidney disease. Diabetes (high blood sugar) is a common cause. Sometimes the medication used to treat high blood pressure may also cause problems with erection and need to be changed not stopped. Never stop your blood pressure medications because of erection problems or impotence. Talk to your doctor so the right blood pressure medication can be prescribed for you that does not have such side effects.
In female patients with advanced kidney disease there is often an absence of menses or abnormal menses, abnormal uterine bleeding and development of cysts in the ovary that disrupt the processes important for ovulation, fertilization, implantation and carrying the pregnancy to full term. It is estimated that only 1-2% of all patients with advanced kidney disease or on dialysis conceive. These chances improve significantly if you get proper care by a good kidney specialist. Only about half of those who conceive can carry their pregnancies to full term and in many cases the pregnancy is complicated by death of the baby in the womb, hypertension in the mother, premature labor and delivery, malformations in the baby and low birth weight of the baby. For patients that are pregnant and already on dialysis, an increased dose and frequency of dialysis preferably on a daily basis is the best chance of successful outcome. It is recommended that pregnant dialysis patients undergo at least 20 hours or more of dialysis a week. The kidney specialist also needs to modify the dialysis prescription to avoid bleeding by reducing the dose of blood thinner given during dialysis. Additional effort to control blood pressure and treat anemia is required. Nutrition is a big issue for pregnant dialysis patients and ensuring the pregnant mother gets enough vitamins including folic acid as well as protein is important. Pregnancy in a dialysis patient is a high risk pregnancy and care should be provided by both a kidney specialist and an obstetrician with experience caring for such patients.
It is important to note that for some women, kidney disease develops for the first time during pregnancy. Infections of the urinary tract need to be treated aggressively because they could lead to generalized infection and kidney failure or death. Some women develop severe high blood pressure along with kidney and liver problems that can also be deadly.
Sexual problems for either men or women with kidney disease can be either physical or emotional. Emotional causes such as fear, anxiety and depression can seriously affect men and women equally and interfere with sexual intercourse, the ability to conceive or ability to carry a pregnancy to term. Healthy eating, exercise, talking to your partner about sexuality and health in an honest open way and following the doctors instructions are one of many ways to help deal with the emotional stress. For most patients, sexuality improves with the initiation of high quality frequent dialysis and gets even better after kidney transplant. Sometimes there may still be problems with sexual drive that persist even after transplant related to use of medications to prevent rejection or treat high blood pressure.
COMMON QUESTIONS ABOUT REPRODUCTION AND PREGNANCY IN KIDNEY DISEASE, DIALYSIS AND TRANSPLANT PATIENTS
Question: Is sexual intercourse safe for a patient with advanced kidney disease or patients on dialysis?
Answer: This is a common fear among such patients and there should be no such concern. Care should be taken to avoid damaging the dialysis access during sexual intercourse however.
Question: Is sexual intercourse safe for patients with a kidney transplant?
Answer: As long as the scar from the transplant surgery is fully healed, blood pressure is controlled and the doctor says it is safe to resume or start sexual activity, there should be no reason to worry about damage to the transplant kidney.
Question: What are the things that can affect a healthy pregnancy?
Answer: General health, age, presence or absence of high blood pressure, high blood sugar, or heart disease, presence of kidney disease.
Question: Can a woman with “mild” kidney disease have a baby?
Answer: Women with mild kidney disease with little or no protein in the urine can conceive and have a healthy pregnancy. Women with more severe kidney disease have a lower likelihood of getting pregnant and higher chance of serious complications during pregnancy which might lead to loss of the pregnancy, worsening of the kidney disease or both. If you have any degree of kidney disease and want to become pregnant, make sure you talk to a kidney specialist along with the doctor that will care for your pregnancy.
Question: Can a patient on dialysis have a baby?
Answer: It is possible but changes in the bodies of men and women on dialysis make it hard to either impregnate a woman or become impregnanted by a man. The risks to the mother and baby are quite high if a woman becomes pregnant on dialysis. If a woman becomes pregnant on dialysis, she will need close attention and very frequent dialysis to have a successful pregnancy.
Question: Can a kidney transplant patient have a baby?
Answer: Yes a woman with a kidney transplant can have a baby. However, it is usually recommended that such patients wait at least 1-2 years after the transplant with stable kidney transplant function before trying to become pregnant. There should be no protein in the urine and the dose of steroids should be at least 15 mg a day or less. Before you try to become pregnant, tell your doctor because in addition to the tests nneded to confirm it is safe to get pregnant, some of the medications used to prevent rejection of the transplant can affect the baby and need to be changed at least 6 weeks or more before any attempts to get pregnant. If the serum creatinine of a transplant patient is above a certain level, it is often recommended that the patient do not get pregnant in order to avoid the possibility of loosing the kidney transplant. Most pregnant kidney transplant patients will need to deliver by cesarean section although normal delivery has been reported. The obstetrician has to plan carefully on the surgical approach and has to consult with the nephrologist and if possible transplant surgeon to avoid damage to the transplant kidney during cesarean section surgery.
Men who have a transplant can father children. There may be some difficulty and if after trying for at least a year there is no success, you should seek the help of a fertility specialist and advice of your kidney doctor.
Question: What kind of birth control is recommended for patients with kidney disease?
Answer: Sometimes it is important to delay plans to become pregnant and birth control is needed. Women with kidney transplants or with high blood pressure should not use oral tablet or implanted hormonal contraceptives as these may increase the risk of rejection or deadly blood clots. These can also increase blood pressure and risk of events like stroke or heart attacks or heart failure. The safest options for birth control involve the use of condoms, diaphragms, sponges and the newer devices that can be placed in the uterus.