Infertility in adults with polycystic kidney disease.

Because of a marked pituitary dysfunction, which is not reversed by dialysis, infertility is frequently a problem in male patients with chronic renal failure (CRF). CRF is associated, in fact, with impaired gonadal steroidogenesis and gametogenesis, elevated gonadotropin levels and attendant alterations in hypothalamic regulation of pituitary-gonadal function [1]. Therefore, any additional cause of infertility can further and dramatically decrease the ability of patients with CRF to conceive. These additional causes can be related to metabolic conditions, such as proteincaloric malnutrition (a frequent complication of CRF, and capable of inducing Leydig cell insufficiency) [2], or extra-renal complications of the primary disease, such as adult polycystic kidney disease (ADPKD). Male patients with ADPKD, a disease responsible for ;6% of all cases of end-stage renal failure in Italy (unpublished data from the 1999 report of the Italian Society on Nephrology), have an increased rate of infertility even before developing advanced renal insufficiency.