Tabassum ELAHI, Saima AHMED, Muhammed MUBARAK
Experimental and Clinical Transplantation - 2026;24(2):87-100
Fertility challenges are significantly more prevalent among individuals with chronic kidney disease compared with healthy populations. Kidney transplant often restores reproductive potential and makes parenthood attainable for many recipients; however, a considerable proportion remains infertile. This infertility is multifactorial, arising from sexual dysfunction, hormonal disturbances, and uremia-induced gonadal toxicity. Patients should be counseled on potential adverse effects of medications for fertility, pregnancy progression, and fetal health. Interdisciplinary care is particularly important for infertile graft recipients, especially women, to safeguard both transplant function and maternal well-being during pregnancy. Evidence indicates that, with appropriate management, parenthood after transplant can be safe and successful, and the risk of congenital anomalies in children of male recipients is comparable to baseline population rates. Assisted reproductive technologies, including in vitro fertilization, have demonstrated effectiveness in this group, although tailored protocols are essential to prevent complications such as ovarian hyperstimulation syndrome. Current evidence on use of assisted reproductive technology in kidney transplant recipients is largely limited to case reports and small studies, underscoring the need for larger, standardized investigations. Here, we provide an overview of reproductive challenges in kidney transplant patients, with a focus on infertility, and highlight emerging strategies in fertility preservation and management aimed at improving clinical outcomes.
