Ovarian reserve in an Egyptian cohort with end-stage kidney disease on hemodialysis and after successful kidney transplantation: a prospective study

Int Urol Nephrol. 2019 Apr;51(4):737-743. doi: 10.1007/s11255-019-02089-2. Epub 2019 Feb 8.

Abstract

Background: Women with chronic kidney disease commonly have menstrual irregularities and fertility abnormalities. Antimüllerian hormone (AMH) and antral follicle count (AFC) are well-recognized indicators of ovarian reserve.

Aims: To assess AMH level and total AFC in women who are on hemodialysis and after successful kidney transplantation (KTx).

Methods: Sixty women with end-stage kidney disease (ESKD) on regular hemodialysis were included in this study with 20 patients of them were going to have renal transplant. Fifty age-matched healthy females were enrolled as control. Serum AMH level was measured in all participants once and in transplant patients four times (before surgery, and at 1, 6, and 12 months after surgery). AFC was evaluated once in all subjects and in transplant patients twice (before and 1 year after surgery).

Results: ESKD patients had significantly lower AMH concentration and AFC than healthy controls (1.8 ± 1.2 vs. 3.5 ± 1.7 ng/ml, p < 0.001) and (12 ± 4.6 vs. 17.4 ± 4.3, p < 0.001), respectively. In the subgroup transplant patients, AMH level decreased significantly from (1.7 ± 1.3 ng/ml) before Ktx to (1.5 ± 1.2 ng/ml, p = 0.001) at 1 month, (1.1 ± 0.9 ng/ml, p < 0.001) at 6 months, (0.9 ± 0.8 ng/ml, p < 0.001) at 1 year after Ktx. Also, total AFC declined in transplant females from (11.1 ± 4.5) before KTx to (6.6 ± 3.4) after KTx (p < 0.001).

Conclusions: Women with ESKD who are on hemodialysis have lower ovarian reserve than healthy females. Moreover, renal transplantation was associated with reduction in AMH level and AFC.

Keywords: Antimüllerian hormone; Antral follicle count; Chronic kidney disease.

MeSH terms

  • Adult
  • Anti-Mullerian Hormone / blood
  • Case-Control Studies
  • Creatinine / blood
  • Egypt
  • Female
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation*
  • Menstrual Cycle
  • Menstruation Disturbances / complications
  • Ovarian Follicle / diagnostic imaging
  • Ovarian Reserve*
  • Postoperative Period
  • Preoperative Period
  • Prospective Studies
  • Renal Dialysis*
  • Ultrasonography

Substances

  • Anti-Mullerian Hormone
  • Creatinine