Treatment of male infertility secondary to morbid obesity


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.


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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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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).

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