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Thinking about starting or adding to your family can be an exciting time. But if you’re a woman who has donated a kidney or received a kidney from someone else, you may have questions. You may wonder how your health after kidney transplant surgery might affect your growing baby — or your ability to get pregnant.

Your doctors can help you prepare for a healthy pregnancy after kidney donation or transplant. Fertility experts can help you become pregnant if you’re having trouble conceiving. But first, it’s important to understand how pregnancy affects your kidneys and how they function.

Pregnancy and Your Kidneys

Your kidney function changes when you’re pregnant. These changes could affect your remaining kidney (if you’re a donor) or your new organ if you’ve received a kidney.

Think of your kidneys as filters that get rid of waste in your blood and remove extra water to produce urine. They do this constant filtering at a steady pace. The rate of this filtering, known as glomerular filtration rate (GFR), tells doctors how well your kidneys are functioning.

During pregnancy, the kidneys pick up their filtering pace. According to a November 2020 article in Advances in Chronic Kidney Disease, your kidneys adjust their function to help keep you and your baby healthy.

The total amount of blood in your body increases by about 50% when you’re pregnant. This extra blood helps carry oxygen and nutrients to your baby. It also means your kidneys are working harder than normal to filter waste products out of your blood.

Additionally, changes in the shape of your kidney tubes help your body store more water, nutrients, and minerals (electrolytes). These extra fluids and nutrients help make sure your baby has what it needs to grow. They also help make sure your kidneys can handle the increased filtering work of pregnancy.

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Getting Pregnant After Kidney Transplant Surgery

Many women who donate a kidney (donor) or receive a donated kidney from someone else (recipient) can become pregnant. Talk with your doctor about your plans to start a family.

Fertility and kidney donors

Doctors recommend that kidney donors wait at least one year after donating to become pregnant. This waiting period gives your body time to heal. Waiting also helps doctors be sure that your remaining kidney is functioning well and can handle the increased filtering needs of pregnancy.

Fertility and kidney recipients

Scheduling a preconception consultation with transplantation and maternal fetal medicine doctors is an important first step to make sure that the pregnancy timing and medication regiment is appropriate.

Generally, transplant recipients should also wait a full year to be sure their new kidney is healthy before conceiving. During this time, your doctor will check your kidney function and ensure that you are rejection free before conceiving. Your doctor will also check any anti-rejection medications (immunosuppressants) and make needed adjustments beforehand in preparation for getting pregnant.

Fertility Problems After Kidney Transplant Surgery

Most women can become pregnant after kidney donation or transplant. But some women experience problems with conceiving. Talk to your doctor to make sure your kidney function is healthy enough to support a pregnancy.

It’s also important to know that trouble getting pregnant may not have anything to do with your transplant surgery.

If you’re unable to conceive after the doctor says your body has healed and that you’re healthy enough to become pregnant, talk to a fertility expert. Experts at UPMC Magee-Womens Hospital offer:

Diagnostic services

Tests to help determine why you’re having trouble getting pregnant include:

  • Blood work.
  • Semen analysis (to check fertility levels in males).
  • Hysterosalpingogram (a special x-ray to see the shape of your uterus and any blockages in your fallopian tubes).
  • Ultrasound.

Fertility planning

If you have other serious health conditions (such as cancer), your doctor may recommend taking steps to preserve your fertility. Egg freezing is a way to put aside healthy eggs for possible future pregnancies.

Fertility treatments

Doctors may recommend certain treatments to help you start your family, including:

  • In vitro fertilization (IVF).
  • Third-party reproductive services, such as donated eggs or sperm, embryo donation, or a pregnancy surrogate.
  • Help with regulating ovulation (ovulation induction).

Pregnancy Complications After Kidney Donation or Transplant

Many women have healthy, uncomplicated pregnancies after donating or receiving a kidney. But there are some things to keep in mind.

Pregnancy and kidney donors

When you choose to donate a kidney, you choose to live with one kidney for the rest of your life. This means you’ll have reduced kidney function, which can put you at risk for certain pregnancy complications.

All women produce more blood during pregnancy, which increases the workload for your kidneys. According to the American Society of Transplantation, donating a kidney puts you at higher risk for:

  • Hypertension (high blood pressure).
  • Preeclampsia (high blood pressure and swelling).

Preeclampsia is a condition that can be dangerous for you and your baby. Your doctor will check you and your baby more frequently if you have preeclampsia. Depending on how far along in your pregnancy you are, doctors may treat this condition with:

  • Early delivery of your baby (if you are at least 37 weeks pregnant).
  • Medications to control your blood pressure.
  • Steroid injections (before 34 weeks of pregnancy) to grow and strengthen your baby’s lungs.

According to a 2020 article in Current Hypertension Reports, preeclampsia can increase your risk of developing kidney disease. Talk with your doctor about how preeclampsia might affect your remaining healthy kidney and its function.

Pregnancy and kidney recipients

During pregnancy, expect your doctor to check your immunosuppressant (anti-rejection) drugs and any other drugs you may take. Your doctor may need to adjust the doses of these medications while you’re pregnant.

Doctors will likely consider your pregnancy to be high risk. You might be more likely to give birth prematurely or have a baby with a lower birth weight. You might also be at higher risk for high blood pressure and preeclampsia during pregnancy.

Maternal fetal medicine experts will care for you and monitor you for any pregnancy complications that might happen. You may need extra screenings, such as:

  • Blood tests.
  • Kidney function tests.
  • Specialized ultrasounds.

When you’re thinking of starting a family after kidney donation or transplant, talk to the experts at UPMC Magee-Womens Hospital.

American Society of Transplantation, How Living Kidney Donation Can Affect Pregnancy, Link.

Clinical Journal of the American Society of Nephrology, Obstetric Nephrology: Renal Hemodynamic and Metabolic Physiology in Normal Pregnancy, Link.

International Journal of Nephrology, Overview of Pregnancy in Renal Transplant Patients, Link.

MedlinePlus, Preeclampsia, Link.

Merck Manual Consumer Version, Physical Changes During Pregnancy, Link.

National Kidney Foundation, Having Children After Transplant? 10 Frequently Asked Questions, Link.

The New England Journal of Medicine, Gestational Hypertension and Preeclampsia in Living Kidney Donors, Link.

About UPMC Magee-Womens

Built upon our flagship, UPMC Magee-Womens Hospital in Pittsburgh, and its century-plus history of providing high-quality medical care for people at all stages of life, UPMC Magee-Womens is nationally renowned for its outstanding care for women and their families.

Our Magee-Womens network – from women’s imaging centers and specialty care to outpatient and hospital-based services – provides care throughout Pennsylvania, so the help you need is always close to home. More than 25,000 babies are born at our network hospitals each year, with 10,000 of those babies born at UPMC Magee in Pittsburgh, home to one of the largest NICUs in the country. The Department of Health and Human Services recognizes Magee in Pittsburgh as a National Center of Excellence in Women’s Health; U.S. News & World Report ranks Magee nationally in gynecology. The Magee-Womens Research Institute was the first and is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology, with locations in Pittsburgh and Erie.