The role of obesity in male fertility
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20183749Keywords:
Hypogonadism, Infertility, Male, Obesity, Sperm parametersAbstract
Obesity causes many health problems as well as having negative effects on fertility. There is a multifaceted relationship between obesity and male infertility. Male fertility is associated with sperm concentration, motility and morphology. Testosterone (total and free) and gonadotropin levels were low and estrogen levels were found to be high in obese men. The decrease in androgen levels varies based on the degree of obesity. High body mass index is inversely related to total sperm count, sperm concentration, sperm morphology and number of motile sperm. Leptin and ghrelin are hormones that influence body weight regulation and eating behaviors. Serum leptin level, which is high in obese infertile men, showed a significant positive correlation with abnormal sperm morphology, serum FSH, LH, prolactin level and showed a significant negative correlation with sperm concentration, sperm motility and serum testosterone level. Further research is needed on the effects of ghrelin levels on male infertility. The relationship between obesity and erectile dysfunction can be explained by decreased testosterone levels and elevation of some proinflammatory cytokine levels. Decreased physical activity due to obesity, long-term sitting increases testicular temperature and affects sperm production negatively. There is a multifaceted relationship between obesity, metabolic syndrome and type 2 diabetes and serum testosterone and SHBG. Diet and exercise showed improvement in testosterone levels and sperm concentration due to decreased body weight. However, studies on this subject are extremely limited. The possible effects of weight loss on successful infertility treatment of obese men should not be ignored.
References
Abdel-Halim RE. Obesity. 1000 years ago. Lancet. 2005;366(9481):204.
Hammoud AO, Gibson M, Peterson CM, Meikle AW, Carrell DT. Impact of male obesity on infertility: a critical review of the current literature. Fertil Steril. 2008;90(4):897-904.
Atif K. Mechanisms linking obesity to male infertility. Cent European J Urol. 2015;68(1):79-85.
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(3):450-2.
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.
Jensen TK, Andersson AM, Jørgensen N, Andersen AG, Carlsen E, Petersen JH, 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.
Sallmén M, Sandler DP, Hoppin JA, Blair A, Baird DD. Reduced fertility among overweight and obese men. Epidemiology. 2006;17(5):520-3.
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.
Hanafy S, Halawa FA, Mostafa T, Mikhael NW, Khalil KT. Serum leptin correlates in infertile oligozoospermic males. Andrologia. 2007;39(5):177-80.
Zorn B, Osredkar J, Meden‐Vrtovec H, Majdic G. Leptin levels in infertile male patients are correlated with inhibin B, testosterone and SHBG but not with sperm characteristics. Int J Androl. 2007;30(5):439-44.
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.
Barnett R. Historical Keywords: Obesity. Lancet. 2005;365(9474):1843.
World Health Organization: Obesity: preventing and managing the global epidemic. 2000, Geneva: WHO Technical Report Series number 894.
Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13(1):37-45.
Cloonan, YK, Holt, VL, Goldberg, J. Male factor infertility: A twin study. Perinatal Epidemiol. 2007;21(3):229-34.
Bonde JP, Ernst E, Jensen TK, Hjollund NH, Kolstad H, Henriksen TB, et al. Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners. Lancet. 1998;352(9135):1172-77.
Slama R, Eustache F, Ducot B, Jensen TK, Jorgensen N, Horte A, et al. Time to pregnancy and semen parameters: a cross-sectional study among fertile couples from four European cities. Hum Reprod. 2002;17(2):503-15.
Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, et al. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med. 2001;345(19):1388-93.
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.
Akingbemi BT. Estrogen regulation of testicular function. Reprod Biol Endocrinol. 2005;3(1):51-63.
Tremellen K, Pearce K. The Effect of Obesity on Male Reproductive Function. Nutrition, Fertility and Human Reproductive Function. 1st ed. Florida:CRC Press; 2015.191-211.
De Boer H, Verschoor L, Ruinemans‐Koerts J, Jansen M. Letrozole normalizes serum testosterone in severely obese men with hypogonadotropic hypogonadism. Diab Obesity Metabol. 2005;7(3):211-5.
Ramlau-Hansen CH, Thulstrup AM, Nohr EA, Bonde JP, Sørensen TI, Olsen J. Subfecundity in overweight and obese couples. Hum Reprod. 2007;22(6):1634-7.
Nguyen RH, Wilcox AJ, Skjærven R, Baird DD. Men's body mass index and infertility. Hum Reprod. 2007;22(9):2488-93.
Håkonsen LB, Thulstrup AM, Aggerholm AS, Olsen J, Bonde JP, Andersen CY, et al. Does weight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men. Reprod Health. 2011;8(1); 24-32.
26. Sermondade N, Faure C, Fezeu L, Shayeb AG, Bonde JP, Jensen TK, et al. BMI in relation to sperm count: an updated systematic review and collaborative meta-analysis. Hum Reprod Update. 2012;19(3):221-31.
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.
Mihalca R, Fica S. The impact of obesity on the male reproductive axis. J Med Life. 2014;7(2):296-300.
Luboshitzky R, Kaplan‐Zverling M, Shen‐Orr Z, Nave R, Herer P. Seminal plasma androgen/oestrogen balance in infertile men. Int J of Andrology. 2002;25(6):345-51.
Pavlovich CP, King P, Goldstein M, Schlegel PN. Evidence of a treatable endocrinopathy in infertile men. J Urol. 2001;165(3):837-41.
Head IM, Eyigör Ö. Kisspeptins and Kisspeptin Neurons: Effects on the Reproductive System and Hypothalamic Placements. J Uludag Uni Faculty of Med. 2011; 37 (1): 53-60.
Koyun E. Obezitenin sperm effect on functions (Derleme). Androl Bülten.2013;15(54):185-9.
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.
Kumanov P, Nandipati K, Tomova A, Agarwal A. Inhibin B is a better marker of spermatogenesis than other hormones in the evaluation of male factor infertility. Fertil Steril. 2006;86(2):332-38.
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.
Caprio M, Fabbrini E, Isidori AM, Aversa A, Fabbri A. Leptin in reproduction. Trends in Endocrinol Metabol. 2001;12(2):65-72.
Hofny ER, Ali ME, Abdel-Hafez HZ, Kamal EE, Mohamed EE, El-Azeem HG, et al. Semen parameters and hormonal profile in obese fertile and infertile males. Fertil Steril. 2010;94(2):581-4.
Dupont J, Maillard V, Coyral-Castel S, Ramé C, Froment P. Ghrelin in female and male reproduction. Int J Peptides. 2010;2010:1-8.
Duran C, Yonem A, Ustun I, Ozcan O, Ipcioglu OM, Basekim CC. Plasma ghrelin levels in males with idiopathic hypogonadotropic hypogonadism. Endocrine. 2008;34(1-3):81-6.
Panidis D, Goulis DG, Katsikis I, Koliakos G, Georgopoulos NA, Diamanti-Kandarakis E. Serum and seminal plasma ghrelin levels in men with normospermia and dyspermia. Gynecol Endocrinol. 2008;24(6):320-5.
Pagotto U, Gambineri A, Pelusi C, Genghini S, Cacciari M, Otto B, et al. Testosterone replacement therapy restores normal ghrelin in hypogonadal men. J Clin Endocrinol Metabol. 2003; 88:4139-43.
Kolotkin RL, Zunker C, Østbye T. Sexual functioning and obesity: a review. Obesity. 2012;20(12):2325-33.
Han TS, Tajar A, O’Neill TW, Jiang M, Bartfai G, Boonen S, et al. Impaired quality of life and sexual function in overweight and obese men: the European Male Ageing Study. Eur J Endocrinol. 2011;164:1003-1011.
Garolla A, Torino M, Miola P, Caretta N, Pizzol D, Menegazzo M, et al. Twenty-four-hour monitoring of scrotal temperature in obese men and men with a varicocele as a mirror of spermatogenic function. Hum Reprod. 2015;30(5):1006-13.
Ivell R. Lifestyle impact and the biology of the human scrotum. Reprod Biol Endocrinol. 2007;5(1):15-29.
Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444(7121):840.
Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444(7121):881.
Li C, Ford ES, Li B, Giles WH, Liu S. Association of testosterone and sex hormone-binding globulin with metabolic syndrome and insulin resistance in men. Diabetes Care. 2010;33(7):1618-24.
Allan CA, Strauss BJ, Burger HG, Forbes EA, McLachlan RI. Testosterone therapy prevents gain in visceral adipose tissue and loss of skeletal muscle in nonobese aging men. J Clin Endocrinol Metab. 2008;93:139-46.
Tsai EC, Matsumoto AM, Fujimoto WY, Boyko EJ. Association of bioavailable, free, and total testosterone with insulin resistance. Diabetes Care. 2004;27(4):861-8.
Wallace IR, McKinley MC, Bell PM, Hunter SJ. Sex hormone binding globulin and insulin resistance. Clin Endocrinol. 2013;78(3):321-9.
Allan CA, McLachlan RI. Androgens and obesity. Current Opinion in Endocrinology, Diabetes Obesity. 2010;17(3):224-32.
Wang C, Jackson G, Jones TH, Matsumoto AM, Nehra A, Perelman MA, et al. Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes Care. 2011;34(7):1669-75.
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.
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.
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.
Corona G, Rastrelli G, Monami M, Saad F, Luconi M, Lucchese M, et al. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis. Eur J Endocrinol. 2013;168(6):829-43.
Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D'Andrea F, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978-84.
Pellitero S, Olaizola I, Alastrue A, Martínez E, Granada ML, Balibrea JM, et al. Hypogonadotropic hypogonadism in morbidly obese males is reversed after bariatric surgery. Obesity Surg. 2012;22(12):1835-42.
Reis LO, Favaro WJ, Barreiro GC, De Oliveira LC, Chaim EA, Fregonesi A, et al. Erectile dysfunction and hormonal imbalance in morbidly obese male is reversed after gastric bypass surgery: a prospective randomized controlled trial. Int J Androl. 2010;33(5):736-44.
Bastounis EA, Karayiannakis AJ, Syrigos K, Zbar A, Makri G, Alexiou D. Sex hormone changes in morbidly obese patients after vertical banded gastroplasty. Eur Surg Res. 1998;30(1):43-47.
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.
Hammoud A, Gibson M, Hunt SC, Adams TD, Carrell DT, Kolotkin RL, et al. Effect of Roux-en-Y gastric bypass surgery on the sex steroids and quality of life in obese men. J Clin Endocrinol Metabol. 2009;94(4):1329-32.
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;20:997-98.
Sermondade N, Massin N, Boitrelle F, Pfeffer J, Eustache F, Sifer C, et al. Sperm parameters and male fertility after bariatric surgery: three case series. Reprod Biomed Online. 2012;24(2):206-10.