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Treatment of male infertility secondary to morbid obesity

Nature Clinical Practice Endocrinology & Metabolism volume 4, pages 415–419 (2008)Cite this article

Abstract

Background A 29-year-old man presented to a clinic with infertility and hypogonadism in the setting of morbid obesity. On presentation, he had notable gynecomastia and a low testicular volume. The patient's weight was 154 kg and his height was 168 cm (BMI 54.5 kg/m2). Before referral to the clinic, the patient had been treated with testosterone therapy for 4 months for hypogonadism. This treatment had caused his initially low sperm concentration to fall to undetectable levels.

Investigations Measurement of reproductive hormone levels, pituitary MRI, and semen analysis.

Diagnosis Infertility secondary to hypogonadotropic hypogonadism and an elevated estrogen:testosterone ratio.

Management Treatment with an aromatase inhibitor, anastrozole, led to normalization of the patient's testosterone, luteinizing hormone and follicle-stimulating hormone levels, suppression of serum estradiol levels, and to normalization of spermatogenesis and fertility.

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Figure 1: The hypothalamic–pituitary–gonadal axis in men and the impact of testosterone therapy and estradiol on spermatogenesis.

References

  1. Hammoud AO et al. (2006) Obesity and male reproductive potential. J Androl 27: 619–626

    Article  Google Scholar 

  2. Raman JD and Schlegel PN (2002) Aromatase inhibitors for male infertility. J Urol 167: 624–629

    Article  CAS  Google Scholar 

  3. Hull MG et al. (1985) Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed) 291: 1693–1697

    Article  CAS  Google Scholar 

  4. Jensen TK et al. (2004) Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men. Fertil Steril 82: 863–870

    Article  CAS  Google Scholar 

  5. Hedley AA et al. (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 291: 2847–2850

    Article  CAS  Google Scholar 

  6. Aggerholm AS et al. (2007) Is overweight a risk factor for reduced semen quality and altered serum sex hormone profile? Fertil Steril [doi:10.1016/j.fertnstert.2007.07.1292]

  7. Sallmen M et al. (2006) Reduced fertility among overweight and obese men. Epidemiology 17: 520–523

    Article  Google Scholar 

  8. Hammoud AO et al. (2008) Male obesity and alteration in sperm parameters. Fertil Steril. [doi:10.1016/j.fertnstert.2007.10.011]

  9. Nguyen RH et al. (2007) Men's body mass index and infertility. Hum Reprod 22: 2488–2493

    Article  Google Scholar 

  10. Fejes I et al. (2006) Effect of body weight on testosterone/estradiol ratio in oligozoospermic patients. Arch Androl 52: 97–102

    Article  CAS  Google Scholar 

  11. Raven G et al. (2006) In men, peripheral estradiol levels directly reflect the action of estrogens at the hypothalamo-pituitary level to inhibit gonadotropin secretion. J Clin Endocrinol Metab 91: 3324–3328

    Article  CAS  Google Scholar 

  12. Sluss PM et al. (2008) Mass spectrometric and physiological validation of a sensitive, automated, direct immunoassay for serum estradiol using the Architect(R). Clin Chim Acta 388: 99–105

    Article  CAS  Google Scholar 

  13. Snyder PJ et al. (2000) Effects of testosterone replacement in hypogonadal men. J Clin Endocrinol Metab 85: 2670–2677

    CAS  PubMed  Google Scholar 

  14. Bhasin S et al. (2006) Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 91: 1995–2010

    Article  CAS  Google Scholar 

  15. Zumoff B et al. (2003) Reversal of the hypogonadotropic hypogonadism of obese men by administration of the aromatase inhibitor testolactone. Metabolism 52: 1126–1128

    Article  CAS  Google Scholar 

  16. de Boer H et al. (2005) Letrozole normalizes serum testosterone in severely obese men with hypogonadotropic hypogonadism. Diabetes Obes Metab 7: 211–215

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank WJ Bremner for helpful comments during the preparation of the manuscript. ST Page is supported, in part, by the National Institute of Aging, a Division of the NIH, by grant K23 AG027238. JK Amory is supported, in part, by the National Institute of Child Health and Human Development, a Division of the NIH, through grant K23 HD45386.

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Authors and Affiliations

  1. MY Roth is a Senior Fellow at the Division of Metabolism, Endocrinology and Nutrition, JK Amory is an Associate Professor of Medicine and ST Page is an Assistant Professor of Medicine, all at the University of Washington School of Medicine, Seattle, WA, USA.,

    Mara Y Roth, John K Amory & Stephanie T Page

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  1. Mara Y Roth
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Correspondence to Stephanie T Page.

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Roth, M., Amory, J. & Page, S. Treatment of male infertility secondary to morbid obesity. Nat Rev Endocrinol 4, 415–419 (2008). https://doi.org/10.1038/ncpendmet0844

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