**4. End Stage Renal Disease (ESRD) affecting fertility**

Female with ESRD have hypothalamic-pituitary-gonadal dysfunction, associated with high follicle stimulating hormone, luteinizing hormone and prolactin levels. Ovulation is sup‐ pressed and mensturation is irregular. Additionally there is sexual dysfunction, suppressed desire and associated psychological factors resulting from chronic ailment. Women on dialysis if conceive present with challenges of worsening of blood pressure controls and anemia, and higher incidences or pre-eclampsia. In 1980, the European Dialysis and Transplant Association reported that only 23% of 115 pregnancies in dialysis ended with surviving infants (European Registry). In 1998, Bagon et al. described a national survey showing a successful outcome in approximately half of the pregnancies in dialysis patients. There are few case series in the new millennium, mainly from single experienced centers, many of which report a successful out‐ come rate of >70% (Romao 1998, Barua 2008). Our own experience is limited with very poor outcome. (Unpublished)
