Anti-Müllerian hormone and fertility in male patients with chronic kidney disease

Abstract
Both men and women with end stage renal disease (ESRD) often suffer from infertility. The reason for this is multifactorial and includes sexual dysfunction, psychological factors and hormonal disturbances. The hypothalamic-pituitary gonadal axis is altered already at moderate reduction in kidney function. Hyperprolactinemia and testosterone deficiency due to Leydig cell impairment have been postulated as causal factors to infertility in earlier studies. In this thesis we present evidence of Sertoli cell impairment also contributing to infertility in men with chronic kidney disease (CKD). Anti-Müllerian hormone is a glycoprotein first discovered in 1947. In men it is exclusively produced in the Sertoli cells and is known to secure the regression of the Müllerian ducts in the male fetus. During the last decades huge progress has been made in the treatment of patients with CKD. Patients with end stage renal disease (ESRD) live longer and their quality of life has improved. It is therefore a wish among these patients, as it is among healthy people, to have children.
We aimed to evaluate Sertoli cell function as well as other reproductive hormones in men with CKD. In this thesis we show for the very first time that levels of AMH are decreased among all men with CKD, being most pronounced in CKD 5. We also show that AMH is associated with sperm motility linking the findings of low AMH to sperm function. Unlike Leydig cell function we could not see a clear recovery of the Sertoli cell function after kidney transplantation.
We also evaluated a new potential biomarker of male infertility, miR-155, and found it to be increased among men with CKD. Furthermore we found decreased sperm concentration already among men with CKD 3-4 compared to healthy fertile controls.
Together we conclude that already a moderate reduction in kidney function may influence male fertility.