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Male Infertility pp 349–360Cite as

Obesity and Male Fertility

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Abstract

The obesity pandemic has grown to concerning proportions in recent years, not only in the Western world but in developing countries as well. The corresponding decrease in male fertility and fecundity may be explained partially by obesity, and obesity should be considered an etiology of male subfertility. Studies show that obesity contributes to infertility by reducing semen quality, changing sperm proteomes, contributing to erectile dysfunction, and inducing other physical problems related to obesity. Mechanisms for explaining the effect of obesity on male infertility include abnormal reproductive hormone levels, an increased release of adipose-derived hormones and adipokines associated with obesity, and other physical problems including sleep apnea and increased scrotal temperatures. Recently, genetic factors and markers for an obesity-related infertility have been discovered and may explain the difference between fertile obese and infertile obese men. Treatments are available for not only infertility related to obesity but also for the other comorbidities arising from obesity. Natural weight loss and bariatric surgery are options for obese patients and have shown promising results in restoring fertility and normal hormonal profiles. Therapeutic interventions including aromatase inhibitors, exogenous testosterone replacement therapy and maintenance, and regulation of adipose-derived hormones, particularly leptin, may also be able to restore fertility in obese males. 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.

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References

  1. World Health Organization. http://www.who.int/nmh/publications/fact_sheet_diet_en.pdf (2009). Accessed 15 July 2009.

  2. Popkin BM. Recent dynamics suggest selected countries catching up to US obesity. Am J Clin Nutr. 2010;91(1):284S–8.

    Article  PubMed  CAS  Google Scholar 

  3. Swan SH, Elkin EP, Fenster L. The question of declining sperm density revisited: an analysis of 101 studies published 1934–1996. Environ Health Perspect. 2000;108(10):961–6.

    Article  PubMed  CAS  Google Scholar 

  4. Sallmen M, Sandler DP, Hoppin JA, Blair A, Baird DD. Reduced fertility among overweight and obese men. Epidemiology. 2006;17(5):520–3.

    Article  PubMed  Google Scholar 

  5. Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992;305(6854):609–13.

    Article  PubMed  CAS  Google Scholar 

  6. Magnusdottir EV, Thorsteinsson T, Thorsteinsdottir S, Heimisdottir M, Olafsdottir K. Persistent organochlorines, sedentary occupation, obesity and human male subfertility. Hum Reprod. 2005;20(1):208–15.

    Article  PubMed  Google Scholar 

  7. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis—part I: review of principles and methods. Clin Nutr. 2004;23(5):1226–43.

    Article  PubMed  Google Scholar 

  8. World Health Organization. Diet, nutrition and the prevention of chronic diseases. World Health Organ Tech Rep Ser. 2003;916:i–viii. 1–149, backcover.

    Google Scholar 

  9. Booth ML, Hunter C, Gore CJ, Bauman A, Owen N. The relationship between body mass index and waist circumference: implications for estimates of the population prevalence of overweight. Int J Obes Relat Metab Disord. 2000;24(8):1058–61.

    Article  PubMed  CAS  Google Scholar 

  10. Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J. Body mass index, waist circumference and waist: hip ratio as predictors of cardiovascular risk–a review of the literature. Eur J Clin Nutr. 2010;64(1):16–22.

    Article  PubMed  CAS  Google Scholar 

  11. Akpinar E, Bashan I, Bozdemir N, Saatci E. Which is the best anthropometric technique to identify obesity: body mass index, waist circumference or waist-hip ratio? Coll Antropol. 2007;31(2):387–93.

    PubMed  Google Scholar 

  12. Macdonald AA, Herbison GP, Showell M, Farquhar CM. The impact of body mass index on semen parameters and reproductive hormones in human males: a systematic review with meta-analysis. Hum Reprod Update. 2010;16(3):293–311.

    Article  PubMed  CAS  Google Scholar 

  13. Hammoud AO, Gibson M, Peterson CM, Hamilton BD, Carrell DT. Obesity and male reproductive potential. J Androl. 2006;27(5):619–26.

    Article  PubMed  Google Scholar 

  14. Jensen TK, Andersson AM, Jorgensen N, et al. Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men. Fertil Steril. 2004;82(4):863–70.

    Article  PubMed  CAS  Google Scholar 

  15. 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(7):2222–31.

    Article  PubMed  CAS  Google Scholar 

  16. Hofny ER, Ali ME, Abdel-Hafez HZ, et al. Semen parameters and hormonal profile in obese fertile and infertile males. Fertil Steril. 2010;94(2):581–4.

    Article  PubMed  CAS  Google Scholar 

  17. Fejes I, Koloszar S, Szollosi J, Zavaczki Z, Pal A. Is semen quality affected by male body fat distribution? Andrologia. 2005;37(5):155–9.

    Article  PubMed  CAS  Google Scholar 

  18. Aggerholm AS, Thulstrup AM, Toft G, Ramlau-Hansen CH, Bonde JP. Is overweight a risk factor for reduced semen quality and altered serum sex hormone profile? Fertil Steril. 2008;90(3):619–26.

    Article  PubMed  CAS  Google Scholar 

  19. Pauli EM, Legro RS, Demers LM, Kunselman AR, Dodson WC, Lee PA. Diminished paternity and gonadal function with increasing obesity in men. Fertil Steril. 2008;90(2):346–51.

    Article  PubMed  CAS  Google Scholar 

  20. Nicopoulou SC, Alexiou M, Michalakis K, et al. Body mass index vis-a-vis total sperm count in attendees of a single andrology clinic. Fertil Steril. 2009;92(3):1016–7.

    Article  PubMed  Google Scholar 

  21. Hammoud AO, Wilde N, Gibson M, Parks A, Carrell DT, Meikle AW. Male obesity and alteration in sperm parameters. Fertil Steril. 2008;90(6):2222–5.

    Article  PubMed  Google Scholar 

  22. Fejes I, Koloszar S, Zavaczki Z, Daru J, Szollosi J, Pal A. Effect of body weight on testosterone/estradiol ratio in oligozoospermic patients. Arch Androl. 2006;52(2):97–102.

    Article  PubMed  CAS  Google Scholar 

  23. Martini AC, Tissera A, Estofan D, et al. Overweight and seminal quality: a study of 794 patients. Fertil Steril. 2010;94(5):1739–43.

    Article  PubMed  Google Scholar 

  24. Kort HI, Massey JB, Elsner CW, et al. Impact of body mass index values on sperm quantity and quality. J Androl. 2006;27(3):450–2.

    Article  PubMed  Google Scholar 

  25. Evenson D, Wixon R. Meta-analysis of sperm DNA fragmentation using the sperm chromatin structure assay. Reprod Biomed Online. 2006;12(4):466–72.

    Article  PubMed  CAS  Google Scholar 

  26. Gopalkrishnan K, Padwal V, Meherji PK, Gokral JS, Shah R, Juneja HS. Poor quality of sperm as it affects repeated early pregnancy loss. Arch Androl. 2000;45(2):111–7.

    Article  PubMed  CAS  Google Scholar 

  27. Kriegel TM, Heidenreich F, Kettner K, et al. Identification of diabetes- and obesity-associated proteomic changes in human spermatozoa by difference gel electrophoresis. Reprod Biomed Online. 2009;19(5):660–70.

    Article  PubMed  CAS  Google Scholar 

  28. Kasturi SS, Tannir J, Brannigan RE. The metabolic syndrome and male infertility. J Androl. 2008;29(3):251–9.

    Article  PubMed  CAS  Google Scholar 

  29. Arsov T, Silva DG, O’Bryan MK, et al. Fat aussie–a new Alstrom syndrome mouse showing a critical role for ALMS1 in obesity, diabetes, and spermatogenesis. Mol Endocrinol. 2006;20(7):1610–22.

    Article  PubMed  CAS  Google Scholar 

  30. Hammoud A, Carrell DT, Meikle AW, et al. An aromatase polymorphism modulates the relationship between weight and estradiol levels in obese men. Fertil Steril. 2010;94(5):1734–8.

    Article  PubMed  CAS  Google Scholar 

  31. Strain GW, Zumoff B, Kream J, et al. Mild hypogonadotropic hypogonadism in obese men. Metabolism. 1982;31(9):871–5.

    Article  PubMed  CAS  Google Scholar 

  32. Tsai EC, Matsumoto AM, Fujimoto WY, Boyko EJ. Association of bioavailable, free, and total testosterone with insulin resistance: influence of sex hormone-binding globulin and body fat. Diabetes Care. 2004;27(4):861–8.

    Article  PubMed  CAS  Google Scholar 

  33. Roth MY, Amory JK, Page ST. Treatment of male infertility secondary to morbid obesity. Nat Clin Pract Endocrinol Metab. 2008;4(7):415–9.

    Article  PubMed  Google Scholar 

  34. Qin DD, Yuan W, Zhou WJ, Cui YQ, Wu JQ, Gao ES. Do reproductive hormones explain the association between body mass index and semen quality? Asian J Androl. 2007;9(6):827–34.

    Article  PubMed  CAS  Google Scholar 

  35. Athyros VG, Tziomalos K, Karagiannis A, Anagnostis P, Mikhailidis DP. Should adipokines be considered in the choice of the treatment of obesity-related health problems? Curr Drug Targets. 2010;11(1):122–35.

    Article  PubMed  CAS  Google Scholar 

  36. Bhat GK, Sea TL, Olatinwo MO, et al. Influence of a leptin deficiency on testicular morphology, germ cell apoptosis, and expression levels of apoptosis-related genes in the mouse. J Androl. 2006;27(2):302–10.

    Article  PubMed  CAS  Google Scholar 

  37. Trayhurn P, Beattie JH. Physiological role of adipose tissue: white adipose tissue as an endocrine and secretory organ. Proc Nutr Soc. 2001;60(3):329–39.

    Article  PubMed  CAS  Google Scholar 

  38. Isidori AM, Caprio M, Strollo F, et al. Leptin and androgens in male obesity: evidence for leptin contribution to reduced androgen levels. J Clin Endocrinol Metab. 1999;84(10):3673–80.

    Article  PubMed  CAS  Google Scholar 

  39. Wang P, Mariman E, Renes J, Keijer J. The secretory function of adipocytes in the physiology of white adipose tissue. J Cell Physiol. 2008;216(1):3–13.

    Article  PubMed  CAS  Google Scholar 

  40. Wozniak SE, Gee LL, Wachtel MS, Frezza EE. Adipose tissue: the new endocrine organ? A review article. Dig Dis Sci. 2009;54(9):1847–56.

    Article  PubMed  Google Scholar 

  41. Jope T, Lammert A, Kratzsch J, Paasch U, Glander HJ. Leptin and leptin receptor in human seminal plasma and in human spermatozoa. Int J Androl. 2003;26(6):335–41.

    Article  PubMed  CAS  Google Scholar 

  42. Bialas M, Fiszer D, Rozwadowska N, Kosicki W, Jedrzejczak P, Kurpisz M. The role of IL-6, IL-10, TNF-alpha and its receptors TNFR1 and TNFR2 in the local regulatory system of normal and impaired human spermatogenesis. Am J Reprod Immunol. 2009;62(1):51–9.

    Article  PubMed  CAS  Google Scholar 

  43. Fraczek M, Kurpisz M. Inflammatory mediators exert toxic effects of oxidative stress on human spermatozoa. J Androl. 2007;28(2):325–33.

    Article  PubMed  CAS  Google Scholar 

  44. Lampiao F, du Plessis SS. TNF-alpha and IL-6 affect human sperm function by elevating nitric oxide production. Reprod Biomed Online. 2008;17(5):628–31.

    Article  PubMed  CAS  Google Scholar 

  45. Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R. Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation. 2005;111(11):1448–54.

    Article  PubMed  Google Scholar 

  46. Davi G, Falco A. Oxidant stress, inflammation and atherogenesis. Lupus. 2005;14(9):760–4.

    Article  PubMed  CAS  Google Scholar 

  47. Agarwal A, Sharma RK, Nallella KP, Thomas Jr AJ, Alvarez JG, Sikka SC. Reactive oxygen species as an independent marker of male factor infertility. Fertil Steril. 2006;86(4):878–85.

    Article  PubMed  CAS  Google Scholar 

  48. Winters SJ, Wang C, Abdelrahaman E, Hadeed V, Dyky MA, Brufsky A. Inhibin-B levels in healthy young adult men and prepubertal boys: is obesity the cause for the contemporary decline in sperm count because of fewer Sertoli cells? J Androl. 2006;27(4):560–4.

    Article  PubMed  CAS  Google Scholar 

  49. Ramaswamy S, Marshall GR, McNeilly AS, Plant TM. Evidence that in a physiological setting Sertoli cell number is the major determinant of circulating concentrations of inhibin B in the adult male rhesus monkey (Macaca mulatta). J Androl. 1999;20(3):430–4.

    PubMed  CAS  Google Scholar 

  50. Bener A, Al-Ansari AA, Zirie M, Al-Hamaq AO. Is male fertility associated with type 2 diabetes mellitus? Int Urol Nephrol. 2009;41(4):777–84.

    Article  PubMed  Google Scholar 

  51. Agbaje IM, Rogers DA, McVicar CM, et al. Insulin dependant diabetes mellitus: implications for male reproductive function. Hum Reprod. 2007;22(7):1871–7.

    Article  PubMed  CAS  Google Scholar 

  52. Lima N, Cavaliere H, Knobel M, Halpern A, Medeiros-Neto G. Decreased androgen levels in massively obese men may be associated with impaired function of the gonadostat. Int J Obes Relat Metab Disord. 2000;24(11):1433–7.

    Article  PubMed  CAS  Google Scholar 

  53. Jarow JP, Kirkland J, Koritnik DR, Cefalu WT. Effect of obesity and fertility status on sex steroid levels in men. Urology. 1993;42(2):171–4.

    Article  PubMed  CAS  Google Scholar 

  54. Globerman H, Shen-Orr Z, Karnieli E, Aloni Y, Charuzi I. Inhibin B in men with severe obesity and after weight reduction following gastroplasty. Endocr Res. 2005;31(1):17–26.

    Article  PubMed  CAS  Google Scholar 

  55. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000;85(3):1151–8.

    Article  PubMed  CAS  Google Scholar 

  56. Luboshitzky R, Lavie L, Shen-Orr Z, Herer P. Altered luteinizing hormone and testosterone secretion in middle-aged obese men with obstructive sleep apnea. Obes Res. 2005;13(4):780–6.

    Article  PubMed  CAS  Google Scholar 

  57. Cheng JY, Ng EM. Body mass index, physical activity and erectile dysfunction: an U-shaped relationship from population-based study. Int J Obes (Lond). 2007;31(10):1571–8.

    Article  CAS  Google Scholar 

  58. Tamler R. Diabetes, obesity, and erectile dysfunction. Gend Med. 2009;6 Suppl 1:4–16.

    Article  PubMed  Google Scholar 

  59. Jung A, Schuppe HC. Influence of genital heat stress on semen quality in humans. Andrologia. 2007;39(6):203–15.

    Article  PubMed  CAS  Google Scholar 

  60. Hjollund NH, Bonde JP, Jensen TK, Olsen J. Diurnal scrotal skin temperature and semen quality. The Danish First Pregnancy Planner Study Team. Int J Androl. 2000;23(5):309–18.

    Article  PubMed  CAS  Google Scholar 

  61. Kaukua J, Pekkarinen T, Sane T, Mustajoki P. Sex hormones and sexual function in obese men losing weight. Obes Res. 2003;11(6):689–94.

    Article  PubMed  CAS  Google Scholar 

  62. Niskanen L, Laaksonen DE, Punnonen K, Mustajoki P, Kaukua J, Rissanen A. Changes in sex hormone-binding globulin and testosterone during weight loss and weight maintenance in abdominally obese men with the metabolic syndrome. Diabetes Obes Metab. 2004;6(3):208–15.

    Article  PubMed  CAS  Google Scholar 

  63. Sharman MJ, Volek JS. Weight loss leads to reductions in inflammatory biomarkers after a very-low-carbohydrate diet and a low-fat diet in overweight men. Clin Sci (Lond). 2004;107(4):365–9.

    Article  CAS  Google Scholar 

  64. Ziccardi P, Nappo F, Giugliano G, et al. Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation. 2002;105(7):804–9.

    Article  PubMed  CAS  Google Scholar 

  65. Lau DC, Douketis JD, Morrison KM, et al. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007;176(8):S1–13.

    Article  PubMed  Google Scholar 

  66. National Institute of Diabetes and Digestive and Kidney Diseases. Prescription medications for the treatment of obesity. http://win.niddk.nih.gov/publications/prescription.htm#fdameds. Accessed 20 July 2009.

  67. Raman JD, Schlegel PN. Aromatase inhibitors for male infertility. J Urol. 2002;167(2 Pt 1):624–9.

    PubMed  CAS  Google Scholar 

  68. Zumoff B, Miller LK, Strain GW. Reversal of the hypogonadotropic hypogonadism of obese men by administration of the aromatase inhibitor testolactone. Metabolism. 2003;52(9):1126–8.

    Article  PubMed  CAS  Google Scholar 

  69. Quennell JH, Mulligan AC, Tups A, et al. Leptin indirectly regulates gonadotropin-releasing hormone neuronal function. Endocrinology. 2009;150(6):2805–12.

    Article  PubMed  CAS  Google Scholar 

  70. Awartani KA, Nahas S, Al Hassan SH, Al Deery MA, Coskun S. Infertility treatment outcome in sub groups of obese population. Reprod Biol Endocrinol. 2009;7:52.

    Article  PubMed  Google Scholar 

  71. Dechaud H, Anahory T, Reyftmann L, Loup V, Hamamah S, Hedon B. Obesity does not adversely affect results in patients who are undergoing in vitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol. 2006;127(1):88–93.

    Article  PubMed  Google Scholar 

  72. Encinosa WE, Bernard DM, Chen CC, Steiner CA. Healthcare utilization and outcomes after bariatric surgery. Med Care. 2006;44(8):706–12.

    Article  PubMed  Google Scholar 

  73. Bastounis EA, Karayiannakis AJ, Syrigos K, Zbar A, Makri GG, Alexiou D. Sex hormone changes in morbidly obese patients after vertical banded gastroplasty. Eur Surg Res. 1998;30(1):43–7.

    Article  PubMed  CAS  Google Scholar 

  74. di Frega AS, Dale B, Di Matteo L, Wilding M. Secondary male factor infertility after Roux-en-Y gastric bypass for morbid obesity: case report. Hum Reprod. 2005;20(4):997–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A19, Cleveland, OH, 44195, USA

    Stephanie Cabler BSc & Ashok Agarwal PhD

  2. Department of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, 19063, Tygerberg, Western Cape, 7505, South Africa

    Stefan S. du Plessis PhD, MBA

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  1. Stephanie Cabler BSc
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  2. Ashok Agarwal PhD
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  3. Stefan S. du Plessis PhD, MBA
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Editors and Affiliations

  1. University of Florida, Director, Robotic Surgery, Winter Haven Hospital &, 200 Avenue F. N.E., Winter Haven, 33881, Florida, USA

    Sijo J. Parekattil

  2. Center for Reproductive Medicine, Department of Urology, Cleveland Clinic, Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Ashok Agarwal

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Cabler, S., Agarwal, A., du Plessis, S.S. (2012). Obesity and Male Fertility. In: Parekattil, S., Agarwal, A. (eds) Male Infertility. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3335-4_33

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