Female Infertility in Chronic Kidney Disease

This review summarises the current literature regarding infertility in women with chronic kidney disease (CKD), describing the epidemiology, pathophysiology, investigations, and management options. The pathophysiology is multifactorial, with proposed mechanisms including disruption of the hypothalamus-pituitary-ovarian axis, chronic inflammation, oxidative stress, psychological factors, and gonadotoxic effects of medications such as cyclophosphamide. Diagnostic investigations in CKD patients seeking to conceive should be considered earlier than in the healthy population. Investigations should include hormonal profiling, including markers such as Anti-Mullerian Hormone and imaging such as ultrasound, to evaluate ovarian reserve and identify gynaecology pathology. Treatment options for infertility in CKD patients include GnRH agonists to preserve ovarian function during cyclophosphamide treatment, as well as assisted reproductive technologies including in vitro fertilisation and ovulation induction. However, these treatments must be tailored to the individual's health status, comorbidities, fertility requirements, and CKD stage. In conclusion, fertility is an important consideration for women with CKD, necessitating early investigation and tailored management. Early discussions regarding fertility are important in order to understand patients' family planning and allow for prompt referral to fertility services. While challenges exist, ongoing research aims to clarify the underlying mechanism and optimise treatment strategies, which are crucial for improving quality of life and overall health outcomes.

Automated summary

This review summarises the current literature on infertility in women with chronic kidney disease (CKD), discussing the epidemiology, pathophysiology, investigations, and management options. The pathophysiology is multifactorial, involving disruption of hormonal axis, inflammation, oxidative stress, psychological factors, and adverse effects of medications. Early investigations in CKD patients seeking to conceive should include hormonal profiling and imaging to evaluate ovarian reserve and gynaecology pathology. Treatment options include preserving ovarian function during cyclophosphamide treatment and assisted reproductive technologies. Tailored management considering individual health, comorbidities, fertility requirements, and CKD stage is crucial. Early discussions and referral to fertility services are important. Ongoing research aims to clarify mechanisms and optimize treatment strategies for better outcomes.