Can I safely try IVF with polycystic kidney disease at 44?

Question

Hello doctor,

I am 44 and just found out I have polycystic kidney disease after an ultrasound showed multiple cysts on both kidneys. My creatinine is 1.8, and GFR dropped to 42 in the last six months, which really scares me. The nephrologist said it is genetic, and now I am worried about my two daughters, who are 19 and 22 years old.

My blood pressure has been really high lately, around 158/98, even though I am on Amlodipine and Lisinopril. The worst part is I am having constant pain in my lower back and sides that keeps me up at night, and Tylenol does not help anymore.

I have also been having more frequent UTIs. I already had three infections this year and just finished antibiotics last week. My periods have been getting heavier and longer since the cystic kidney disease diagnosis, and I am not sure if that is related. The doctor mentioned something about Tolvaptan to slow down cyst growth, but said it might affect my liver, and I already have fatty liver. I am supposed to start trying IVF next month because we have been trying to conceive for three years, but I am now worried about passing this disease to my baby.

Can I still do fertility treatments with polycystic kidney disease?
What are the chances my kidneys will fail completely?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your question, and I will address your gynecology-related concerns clearly.

You have autosomal dominant polycystic kidney disease (ADPKD). This condition can be passed on to children, and each daughter has about a 50 percent chance of inheriting the gene. If they are not showing symptoms right now, testing can be done later when they are older or when it becomes relevant.

If you are considering pregnancy, IVF (in vitro fertilization) is an option. With newer techniques like PGT (preimplantation genetic testing), embryos can be screened so that only those without the autosomal dominant polycystic kidney disease (ADPKD) gene are selected. Pregnancy in ADPKD (the most common inherited kidney disease, causing fluid-filled cysts to form in the kidneys and other organs like the liver and pancreas) is possible, but it does require close monitoring throughout.

There are some added risks during pregnancy, such as high blood pressure, pre-eclampsia (a condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria), or eclampsia (a condition in which one or more convulsions occur in a pregnant woman suffering from high blood pressure, often followed by coma and posing a threat to the health of mother and baby), and faster growth of kidney cysts. Because of this, regular follow-ups are very important.

Regarding Tolvaptan, it can slow down cyst growth, but it needs careful supervision. Frequent blood tests are required to monitor liver function, and the decision to continue it should be made cautiously after weighing the benefits and risks.

If blood pressure remains well controlled and infections are prevented, the risk of kidney failure can be reduced. However, there is still a possibility that kidney function may worsen over time, and some people may need dialysis in the future.

Your long-term outlook depends a lot on:

Good blood pressure control.
Prompt treatment of infections.
Avoid medicines that can harm the kidneys.
Regular monitoring of kidney progression.

You also need to get these tests done:

TSH (thyroid-stimulating hormone).
HbA1C (glycated hemoglobin).
PRL (prolactin levels).
FBS (fasting blood sugar).
USG (ultrasound sonography) for the pelvic adnexa (structures beside the uterus in the female pelvis).

Your menstrual concerns are not directly related to ADPKD and need a separate evaluation. This usually involves hormone tests and an ultrasound scan of the uterus to find the exact cause.

I strongly recommend an in-person gynecological examination. Please get the suggested tests done and revert.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.