13 - Assisted reproduction in women with renal disease

Summary

Introduction

Thirty years ago when Louise Brown was born, history was made as the first child conceived through in vitro fertilisation was delivered. It is perhaps just as important to note that in 2008 it will be 50 years since the first child was born to a woman who had received a renal transplant. There can be no doubt that advances in medical care have dramatically improved the quality of life and life expectancy of women with chronic kidney disease (CKD). With these changes have come improvements in fertility and as such it is now necessary to consider prepregnancy counselling for all women with renal disease who fall into a reproductive age group. For most women this counselling will centre on a risk assessment for pregnancy, a discussion about the likely outcomes of a pregnancy based on this risk assessment and then a consideration as to the timing of pregnancy, with advice being given regarding contraception. Prepregnancy optimisation of both renal function and general dietary supplementation and other factors such as smoking cessation should be discussed.

At the same time as advances have been seen in the medical management of renal disease, women will be aware of improvement in the management of subfertility, with many of these services being available through publicly funded healthcare systems or being affordable to many women through the private medical system.