The effect of obesity on sperm disorders and male infertility

Abstract

The results of several studies point to an increased likelihood of abnormal semen parameters among overweight men, and an elevated risk for subfertility among couples in which the male partner is obese. Obesity is, therefore, associated with a higher incidence of male factor infertility. Several mechanisms might account for the effect of obesity on male infertility, both directly and indirectly, by inducing sleep apnea, alterations in hormonal profiles (reduced inhibin B and androgen levels accompanied by elevated estrogen levels) and increased scrotal temperatures, ultimately manifesting as impaired semen parameters (decreased total sperm count, concentration and motility; increased DNA fragmentation index). Neither the reversibility of obesity-associated male infertility with weight loss nor effective therapeutic interventions have been studied in-depth. The increasing prevalence of obesity calls for greater clinical awareness of its effects on fertility, better understanding of underlying mechanisms, and exploration into avenues of treatment.

Key Points

  • Male factor infertility is associated with a higher incidence of obesity

  • Obesity has been proposed to affect male fertility both directly and indirectly, by inducing alterations in sleep and sexual behavior, hormonal profiles, scrotal temperatures and semen parameters

  • Several potential mechanisms might account for the effect of obesity on male infertility

  • Obesity might cause aromatase overactivity, affect the endocrinological properties of white adipose tissue, and induce oxidative stress and dysregulation of the hypothalamic–pituitary–gonadal axis

  • Weight loss, gastric bypass surgery and the management of hormonal imbalance might prove useful interventions in the reversal of obesity-induced infertility

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Figure 1: The role of adipocytes in male infertility.
Figure 2: Dysregulation of the typical hypothalamic–pituitary–gonadal axis as a consequence of obesity.

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Du Plessis, S., Cabler, S., McAlister, D. et al. The effect of obesity on sperm disorders and male infertility. Nat Rev Urol 7, 153–161 (2010). https://doi.org/10.1038/nrurol.2010.6

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