This is a follow up story about a patient who donated a kidney to her new husband’s chronically ill mother.
The first article, Tubal Reversal With One Kidney: A Tubal Reversal Angel Spreads Her Wings, presented the story of Brandy and Maruice.
Brandy came to A Personal Choice for an outpatient tubal reversal of burned tubes. In a tremendous act of love, Brandy donated a kidney to her husbands sick mother.
Now she must face the new obstacle of attempting to become pregnant and have a successful pregnancy while only having one kidney.
One Kidney: Tubal Reversal or IVF?
Both tubal reversal and IVF could pose risks to a person with one kidney. The main risk of tubal reversal to a woman with one kidney is the limitations of treatment options for an ectopic pregnancy. The main risk of IVF to a women with one kidney is the possibility of a multiple gestation and blood pressure abnormalities during pregnancy.
Ligation Reversal and One Kidney
The main risk of ligation reversal and pregnancy in a patient with one kidney is not the surgery itself, but having one kidney can limit the treatment options for ectopic pregnancy. The main risk of tubal reversal is an increased risk of ectopic pregnancy.
This can be diagnosed early and treated effectively by following our Early Pregnancy Protocol. The treatment of an early ectopic pregnancy can be accomplished safely and without surgery, but requires methotrexate medication. One reason not to give methotrexate is impaired kidney function.
Due to Brandy having only one kidney, she may not be able to have methotrexate treatment for an ectopic pregnancy and may require surgery for treatment.
IVF and One Kidney
IVF also has risks in a woman with one kidney. The main risk of IVF is the risk of a multiple gestation (twins or greater). A significant number of IVF pregnancies will be a multiple gestation pregnancy. Multiple gestation pregnancies are at increased risk of preeclampsia. With one kidney and a multiple gestation pregnancy, the chance of having preeclapsia is almost a guaranteed certainty.
Pregnancy and One Kidney
Regardless of the way Brandy becomes pregnant (IVF or tubal reversal), she will face a high-risk pregnancy because of her having only one kidney. She will have a much higher risk of having preeclampsia (toxemia). This is a condition in which the mothers blood pressure can go dangerously high. This can result in seizures, stroke, and death to the baby and mother.
Brandy and her health specialists will also have to watch her very carefully to make sure her baby is not sufferring from growth restriction and also to make sure she is not experiencing any irreparable harm to her kidney. Although extremely rare, permanent kidney damage to her last remaining kidney is possible.
Tubal Reversal Advice
I spoke with Brandy and Maurice at length about the risk in pregnancy with one kidney. I told her it was going to be extremely important to have good communication with both her nephrologist and her ob gyn doctor. I advised Brandy to ask her nephrologist if she would be a candidate for methotrexate treatment and to provide her with documentation stating such to take to her ob gyn doctor.
Although the functioning of her remaining kidney is very good, it is possible she could receive methotrexate for an ectopic pregnancy; however, she would also not want to risk methotrexate damaging her last remaining kidney. I advised her to discuss the possibility of methotrexate carefully with her kidney specialist. It would not be in her best interest to have an ectopic pregnancy and be trying to figure the best treatment out at the last moment.
There will also need to be clear communication among Brandy, her nephrologist, her ob/gyn, and her maternal fetal specialist when she does become pregnant. This communication will be important to monitor both her health and the health of her baby.
Does Reversing Tubes Work?
Tubal reversal does work and tubal reversal can very successful for many women.
For many tubal reversal can be more affordable and more successful than the alternative treatment of in-vitro fertilization.
I am happy to report to readers Brandy had an uneventful pregnancy and delivery without complications. She had a healthy baby girl and as you can see she has grown quite a bit!
For more information readers can view Brandy’s pregnancy testimonial: Tubal Reversal Babies Are Beautiful
Submitted by Dr. Charles Monteith
