Spermatogenesis Recovery After Kidney Transplantation in an Azoospermic Male

Ngoc Thai, N, Huynh Dang Khoa H

End-stage kidney disease, azoospermia, male infertility, kidney transplantation

Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) significantly impact male fertility, leading to hormonal imbalances, reduced spermatogenesis, and azoospermia. Kidney transplantation (KTx) is known to restore endocrine function and potentially improve fertility outcomes. We present a case of an azoospermic male with ESKD who successfully achieved natural conception after KTx. A 32-year-old male, married for four years, presented with infertility, low libido, and mild erectile dysfunction. He had CKD stage 3 due to chronic glomerulonephritis and hypertension, which progressed to ESKD without dialysis. Laboratory tests showed elevated LH and FSH, low testosterone, and azoospermia on repeated semen analyses. Physical examination revealed small testicular volume. Genetic testing excluded karyotypic abnormalities and Y-chromosome microdeletions. Given the patient's condition, two treatment options were considered: microdissection testicular sperm extraction (mTESE) with IVF or kidney transplantation followed by fertility reassessment. The patient underwent KTx, leading to normalization of renal function and a gradual improvement in hormonal balance. Four months post-transplant, semen analysis demonstrated sperm recovery (11 million/mL, 47% motility), and the couple achieved natural conception. This case highlights the potential for fertility restoration in azoospermic men with ESKD following KTx. The findings support a tailored approach to infertility management in CKD patients, considering KTx as a viable strategy for hormonal and spermatogenic recovery. Further research is needed to evaluate long-term fertility outcomes and the influence of immunosuppressive therapy on spermatogenesis. 

We acknowledge the support of Dr. Cipto Mangunkusumo Hospital, Urological Association of Asia, Faculty of Medicine Universitas Indonesia, Indonesian Urological Association, and Indonesian Society of Andrological Urology (InaSAU).

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