Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 155

Women who are renal transplant recipients are at higher risk than the general population of having their IVF treatment complicated by ovarian hyperstimulation (OHSS) [13]. Approximately 10% of gonadotropins are excreted renally [1]. Therefore, if renal clearance is not at optimal levels, gonadotropins may have an enhanced effect on renal transplant recipients, leading to OHSS. This can lead to intravascular dehydration, oliguria and deterioration of renal function and so ovarian stimulation must be well monitored and be carried out cautiously using lower gonadotropin doses [13]. Additionally, enlarged ovaries due to OHSS can lead to ureteric obstruction causing further deterioration of renal function [16].

The position of the transplanted kidney should be known prior to embarking IVF treatment. Access to the ovaries for oocyte retrieval may also be difficult if the allografted kidney is situated in the pelvis. Resultant elevated estradiol levels from ovarian stimulation may lead to higher risks of thrombo‐embolic disease in renal transplant recipients [13]. This is especially the case in some renal patients who may have pro‐thrombotic conditions such as systemic lupus erythematosus (SLE) with antiphospholipid autoantibodies.