Introduction:
Chronic kidney disease is associated with decreased chance of pregnancy. However after renal transplantation with normal renal graft function a transplanted women will restore her normal ovulation cycle and this will increased the chance of pregnancy, on other hand in kidney transplanted who is infertile in vitro fertilizations is an optional approach.
Methods:
We reported a 36 years old female patient, status post live related renal transplantation from her brother maintained on triple immunosuppressive medications including: tacrolimus ,mycophenolate mofetil and prednisolone. The aetiology of renal failure is long standing uncontrolled hypertension.
After failed attempts of normal pregnancy the patient underwent IVF 5 years post transplantation. mycophenolate mofetil was stopped and replaced by azathioprine. Then planned for IVF as per protocol fortunately she had successful IVF from first attempt with twins. Throughout her pregnancy the patient followed regularly. Her renal graft function remains stable with drop in creatinine as physiologically expected in pregnancy. her blood pressure remain within normal limits with no proteinuria reported. The tacrolimus dose was adjusted according to the level.She delivered at full term healthy two girls by caesarean section.
Results:
In vitro fertilizations is an option for pregnancy in infertile women and can be considered in women with history of renal transplant. several aspects should be considered before IVF attempt first to select the optimal time to perform the procedure within one year or preferably after two year of renal transplant with normal renal graft function. During pregnancy these patients are at risk of worsening renal graft function, increased proteinuria, and may sustain uncontrolled hypertension and preeclampsia in the mother. As well as risk factors to the foetus including: low birth weight, intrauterine growth restriction and prematurity.
The Immunosuppressive medication should be closely monitored. Mycophenolate mofetil should be replaced by azathioprine preferably two months prior to fertilization.
Tacrolimus level should be monitred and optimize the dose , prednisolone to be continued however stress dose may needed at time of delivery.
In general pregnancy is challenging in renal transplant patient and in certain cases reported to trigger graft dysfunction , rejection and shorten the graft survival . The data on IVF post transplantation is relatively limited thus the decision to perform the procedure was challenging and needs multidisciplinary team approach including transplant nephrologist, obstetrician, foetal and maternal medicine specialist.
Conclusions:
In vitro fertilization is a procedure that can be performed in renal transplant patients. However the risks and complications on the mother and fetus should be explained and monitored closely. This procedure need multidisciplinary team approach.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.