Reporting a Case Study with Minireview: Exceptional Fertility and Poor Fetal Outcome in a Female with 17-Year Hemodialysis

Abstract

Background: Chronic kidney disease can affect different aspects of female patient’s life including menstrual pattern, marital status and sexuality, fertility, pregnancy outcome, and recommended methods of contraception especially when initiated on HD. It is an underestimated problem in both genders and has not been evaluated comprehensively. In Egypt, it has been noticed that it is infrequent for a hemodialysis (HD) female to start her marriage after initiation of HD; this may be attributed to a negative self-image experienced by the patient and perceived by the community. Moreover, it is also less common for an HD patient to marry another HD partner and it is odd for them to conceive during HD.

Aim: To describe the possibility of starting family and plan for successful pregnancy during the course of HD therapy in patients with ESRD.

Patient Scenario: Our case is a 36 years old Egyptian female who started HD in 1999 and continued on HD for 17 years. She married four times and conceived five times from three husbands. She got live birth only once from her second HD husband, but unfortunately, the baby died within a few days. The patient used Implanon - with its possible side effects- as a method of contraception during her last four years of life. After hectic 17 years under HD and unfortunate marital and fertility events, she decided to withdraw from her dialysis program, chose to live in isolation, and passed away within five days as a consequence of cerebral hemorrhage.

Results and Conclusions: If needed, contraception methods must be chosen carefully with a multi-disciplinary discussion between the obstetrician, the patient, the family, and the nephrologist. Fertility and successful pregnancies are believed to be possible in HD couples if they receive proper care.