The effect of body mass index on sperm DNA fragmentation: a systematic review and meta-analysis



Current evidence supports the association between the high sperm DNA fragmentation (SDF) and the poor fertilization rate following either natural conception or assisted reproductive techniques (ART). On the other hand, there are conflicting results regarding the decreased sperm DNA integrity in men with high body mass index (BMI).


We aimed at the present systematic review and meta-analysis at evaluating the association between BMI and SDF.


We searched databases of Medline, Embase, Scopus, and Web of Science up to May 2019, to identify observational studies that assessed the associations between BMI and SDF. BMI was classified, according to the standard BMI classifications, into six categories including underweight (<18.5), normal weight (18.5–24.99), overweight (25–29.99), class I obesity (30–34.99), class II obesity (35–39.99), and class III obesity (≥40). Standardized mean differences (SMDs) and 95% confidence intervals (CIs) of SDF were calculated by using a random-effects model for BMI categories.


The initial extensive literature search yielded 33,739 potentially relevant articles (3,917 from Medline, 781 from Embase, 12,685 from Scopus, and 9,348 from Web of Science). Fourteen studies (nine cross-sectional, four cohort, and one case–control studies), with a total number of 8,255 participants, were included in the meta-analysis. Finally, three studies reported higher SDF levels in obese men (BMI = 30–34.99) compared with normal-weight men (BMI < 25) (SMD: 0.23, 95% CI: 0.01, 0.46, P = 0.05, I2 = 0%), but there was no difference between other categories.


There is insufficient data to demonstrate a positive association between BMI and SDF. Our findings provide a rationale for conducting further cohort studies for evaluation of the association between BMI and SDF, considering potential confounders.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8


  1. 1.

    Wright C, Milne S, Leeson H. Sperm DNA damage caused by oxidative stress: modifiable clinical, lifestyle and nutritional factors in male infertility. Reprod Biomed Online. 2014;28:684–703.

  2. 2.

    Henkel RR, Franken DR. Sperm DNA fragmentation: origin and impact on human reproduction. J Reprod Stem Cell Biotechnol. 2011;2:88–108.

  3. 3.

    Chrysohoou C, Panagiotakos DB, Pitsavos C, Skoumas I, Papademetriou L, Economou M, et al. The implication of obesity on total antioxidant capacity in apparently healthy men and women: the ATTICA study. Nutr Metab Cardiovasc Dis. 2007;17:590–7.

  4. 4.

    Fernández-Sánchez A, Madrigal-Santillán E, Bautista M, Esquivel-Soto J, Morales-González Á, Esquivel-Chirino C, et al. Inflammation, oxidative stress, and obesity. Int J Mol Sci. 2011;12:3117–32.

  5. 5.

    Craig JR, Jenkins TG, Carrell DT, Hotaling JM. Obesity, male infertility, and the sperm epigenome. Fertil Steril. 2017;107:848–59.

  6. 6.

    Bandel I, Bungum M, Richtoff J, Malm J, Axelsson J, Pedersen HS, et al. No association between body mass index and sperm DNA integrity. Hum Reprod. 2015;30:1704–13.

  7. 7.

    Chavarro JE, Toth TL, Wright DL, Meeker JD, Hauser R. Body mass index in relation to semen quality, sperm DNA integrity, and serum reproductive hormone levels among men attending an infertility clinic. Fertil Steril. 2010;93:2222–31.

  8. 8.

    Dupont C, Faure C, Sermondade N, Boubaya M, Eustache F, Clement P, et al. Obesity leads to higher risk of sperm DNA damage in infertile patients. Asian J Androl. 2013;15:622–5.

  9. 9.

    Kort HI, Massey JB, Elsner CW, Mitchell-Leef D, Shapiro DB, Witt MA, et al. Impact of body mass index values on sperm quantity and quality. J Androl. 2006;27:450–2.

  10. 10.

    Lu JC, Jing J, Chen L, Ge YF, Feng RX, Liang YJ, et al. Analysis of human sperm DNA fragmentation index (DFI) related factors: a report of 1010 subfertile men in China. Reprod Biol Endocrinol. 2018;16:23.

  11. 11.

    Oliveira JBA, Petersen CG, Mauri AL, Vagnini LD, Renzi A, Petersen B, et al. Association between body mass index and sperm quality and sperm DNA integrity. A large population study. Andrologia 2018;50:e12889.

  12. 12.

    Eisenberg ML, Kim S, Chen Z, Sundaram R, Schisterman EF, Buck Louis GM. The relationship between male BMI and waist circumference on semen quality: data from the LIFE study. Hum Reprod. 2014;29:193–200.

  13. 13.

    Fariello RM, Pariz JR, Spaine DM, Cedenho AP, Bertolla RP, Fraietta R. Association between obesity and alteration of sperm DNA integrity and mitochondrial activity. Bju Int. 2012;110:863–7.

  14. 14.

    Andersen JM, Herning H, Aschim EL, Hjelmesaeth J, Mala T, Hanevik HI, et al. Body mass index is associated with impaired semen characteristics and reduced levels of anti-mullerian hormone across a wide weight range. PLoS ONE 2015;10:e0130210.

  15. 15.

    Andersen JM, Ronning PO, Herning H, Bekken SD, Haugen TB, Witczak O. Fatty acid composition of spermatozoa is associated with BMI and with semen quality. Andrology. 2016;4:857–65.

  16. 16.

    Thomsen L, Humaidan P, Bungum L, Bungum M. The impact of male overweight on semen quality and outcome of assisted reproduction. Asian J Androl. 2014;16:749–54.

  17. 17.

    Taha EA, Sayed SK, Gaber HD, Abdel Hafez HK, Ghandour N, Zahran A, et al. Does being overweight affect seminal variables in fertile men? Reprod Biomed Online. 2016;33:703–8.

  18. 18.

    Leisegang K, Bouic PJD, Menkveld R, Henkel RR. Obesity is associated with increased seminal insulin and leptin alongside reduced fertility parameters in a controlled male cohort. Reprod. Biol. Endocrinol. 2014;12:34.

  19. 19.

    Rybar R, Kopecka V, Prinosilova P, Markova P, Rubes J. Male obesity and age in relationship to semen parameters and sperm chromatin integrity. Andrologia. 2011;43:286–91.

  20. 20.

    Zini A, Boman JM, Belzile E, Ciampi A. Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis. Hum Reprod. 2008;23:2663–8.

  21. 21.

    Simon L, Zini A, Dyachenko A, Ciampi A, Carrell DT. A systematic review and meta-analysis to determine the effect of sperm DNA damage on in vitro fertilization and intracytoplasmic sperm injection outcome. Asian J Androl. 2017;19:80.

  22. 22.

    Li Z, Wang L, Cai J, Huang H. Correlation of sperm DNA damage with IVF and ICSI outcomes: a systematic review and meta-analysis. J Assist Reprod Genet. 2006;23:367–76.

  23. 23.

    Zhao J, Zhang Q, Wang Y, Li Y. Whether sperm deoxyribonucleic acid fragmentation has an effect on pregnancy and miscarriage after in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis. Fertil Steril. 2014;102:998–1005. e8

  24. 24.

    Zhang Z, Zhu L, Jiang H, Chen H, Chen Y, Dai Y. Sperm DNA fragmentation index and pregnancy outcome after IVF or ICSI: a meta-analysis. J Assist Reprod Genet. 2015;32:17–26.

  25. 25.

    Osman A, Alsomait H, Seshadri S, El-Toukhy T, Khalaf Y. The effect of sperm DNA fragmentation on live birth rate after IVF or ICSI: a systematic review and meta-analysis. Reprod Biomed Online. 2015;30:120–7.

  26. 26.

    Tamburrino L, Marchiani S, Montoya M, Marino FE, Natali I, Cambi M, et al. Mechanisms and clinical correlates of sperm DNA damage. Asian J Androl. 2012;14:24.

  27. 27.

    Sakkas D, Alvarez JG. Sperm DNA fragmentation: mechanisms of origin, impact on reproductive outcome, and analysis. Fertil steril. 2010;93:1027–36.

  28. 28.

    Aitken RJ, De Iuliis GN. Origins and consequences of DNA damage in male germ cells. Reprod Biomed Online. 2007;14:727–33.

  29. 29.

    Kumar N, Singh AK. Reactive oxygen species in seminal plasma as a cause of male infertility. J. Gynecol. Obstet. Hum. Reprod. 2018;47:565–72.

  30. 30.

    Lobascio A, De Felici M, Anibaldi M, Greco P, Minasi M, Greco E. Involvement of seminal leukocytes, reactive oxygen species, and sperm mitochondrial membrane potential in the DNA damage of the human spermatozoa. Andrology. 2015;3:265–70.

  31. 31.

    Aktan G, Doğru-Abbasoğlu S, Küçükgergin C, Kadıoğlu A, Özdemirler-Erata G, Koçak-Toker N. Mystery of idiopathic male infertility: is oxidative stress an actual risk? Fertil Steril. 2013;99:1211–5.

  32. 32.

    Zini A, San Gabriel M, Baazeem A. Antioxidants and sperm DNA damage: a clinical perspective. J Assist Reprod Genet. 2009;26:427–32.

  33. 33.

    Ferramosca A, Di Giacomo M, Moscatelli N, Zara V. Obesity and male infertility: role of fatty acids in the modulation of sperm energetic metabolism. Eur J Lipid Sci Technol. 2018;120:1700451.

  34. 34.

    Aitken RJ, Koppers AJ. Apoptosis and DNA damage in human spermatozoa. Asian J Androl. 2011;13:36.

Download references

Author information

Correspondence to Maryam Razavi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sepidarkish, M., Maleki-Hajiagha, A., Maroufizadeh, S. et al. The effect of body mass index on sperm DNA fragmentation: a systematic review and meta-analysis. Int J Obes 44, 549–558 (2020).

Download citation