Male Obesity and Semen
Analysis Parameters
Joseph Petty, MD
Samuel Prien, PhD
Amantia Kennedy, MSIV
Sami Jabara, MD
Background: Obesity
• Obesity is a growing problem.
• The Behavioral Risk Factor Surveillance
System, in conjunction with the CDC,
conducted a national survey and found
that in 2000, the prevalence of obesity
(BMI >30 kg/m2) was 19.8%, a 61%
increase since 1991.
Background: Obesity
• Obesity affects female and male fertility.
• In a study comparing IVF success rates
and female obesity, it was shown that a
0.1 unit increase in waist-hip ratio led to a
30% decrease in probability of conception
per cycle 2.
• In couples complaining of infertility, male
factor plays a role in up to 40% of cases.
Background: Semen Parameters
• What parameters best predict fertility?
• National Cooperative Reproductive
Medicine Network: 765 infertile couples
(no conception after 12 months), and 696
fertile couples
• greatest discriminatory power was in the
percentage of sperm with normal
morphologic features.
Hypothesis
• Since there is an observed correlation
between obesity and male factor infertility,
our hypothesis is that an increased BMI is
associated with higher rate of abnormal
semen parameters, especially sperm
morphology.
Recent Studies
• Danish study by Jensen et al. enrolled 1,558
young men (mean 19 years old) when they
presented for their compulsory physical exam as
part of their country’s military drafting system.
• The authors showed decreased sperm counts
and concentration (39 million/mL vs.
46million/mL) in those with an elevated BMI
(>25kg/m2). They did not, however, observe a
difference in morphology.
• Hormonal differences
Recent Studies
• Kort et al. looked at semen analysis
results in 520 men
• grouped according to their BMI, and
measured the average normal-motilesperm count (NMS = volume x
concentration x %motility x %morphology)
• Kort concluded that men with high BMI
values (>25) present with few normalmotile sperm cells
Recent Studies
• Hammoud et al., showed a increased
incidence of oligospermia and increased
BMI and also showed decreased levels of
progressively motile sperm
• Considered each parameter separately.
Sexual function
• Agricultural study: The association between BMI
and infertility was similar for older and younger
men, disproving the theory that erectile
dysfunction in older men is a significant factor.
• Hammoud et al., though primarily concerned
with hormones, looked at erectile dysfunction
directly and showed that there was no
correlation with increases in BMI
• Nguyen et al., effect of BMI is essentially
unchanged regardless of coital frequency,
suggesting that decreased libido in overweight
men is not a significant factor
Hormonal Profile
• Danish study, observed decreased FHS and
inhibin B levels in the obese.
• Pauli et al., observed with increases in BMI a
decreased total T, decreased SHBG, increased
estrogen and decreased FSH and inhibin B.
• Inhibin B, cited for its usefulness as a novel
marker for spermatogenesis and its role in
pituitary gonadotropin regulation.
• Pauli: no correlation of BMI or skinfold thickness
with semen analysis parameters, though it was
observed that men with proven paternity versus
those without had lower BMI.
Interventions: Gastric Bypass
• One case series of 6 male patients after
bariatric surgery showed secondary
azoospermia with complete spermatogenic
arrest.
• none of the subjects had a semen analysis
before the bariatric surgery, but all had
fathered a pregnancy previously
• malabsorption of nutrients
Interventions
• Hammoud et al., part of Utah Obesity Study
• effect of the gastric bypass surgery on sex
steroids and sexual function
• Cohort of 64 severely obese men
• Along with a significant decrease in BMI, they
found decreased levels of estradiol, and
increases in total and free testosterone along
with a reported improvement in quality of sexual
function.
• Semen analysis parameters were not
considered in this study
Study Design
• Retrospective chart review for all couples
and individual patients presenting for an
infertility consultation and evaluation at the
Texas Tech Physicians Center for Fertility
and Reproductive Surgery from
September 2005 through January 2008.
• Intake questionnaire: demographic,
medical, surgical and fertility history.
Questionnaire
• Previous pregnancies fathered: current or previous
partner
• Psychiatric disorders included any degree of depression,
bipolar disorder or any other psychiatric disorder
requiring medical therapy.
• Tobacco and alcohol users: whether they admitted to
light, moderate, or heavy use, patient underreporting.
• Chemical exposures: contact with pesticides, herbicides,
and heavy metals.
• Sexual dysfunction: mainly erectile dysfunction and
decreased libido.
• Genitourinary anomalies: hypospadias, varicocele,
genitourinary surgery, testicular torsion or inguinal hernia
or trauma
• Other medical problems included mainly diabetes,
hypertension, thyroid disease, autoimmune disease, and
cancer.
Study Design
• Patients grouped according to their BMI as normal (2024 kg/m2, N = 24), overweight (25-30 kg/m2, N = 43), or
obese (>30 kg/m2, N = 45), as standardized by the
World Health Organization
• Semen analysis parameters: morphology, volume,
concentration, percent motility, and presence of absence
of agglutination, in accordance with World Health
Organization (WHO) guidelines
• SPSS statistical software was used to run analysis of
variance (ANOVA) and post-hoc Tukey HSD tests
between the groups. A p-value <0.05 was considered
statistically significant.
Exclusion Criteria
• questionnaire was missing or if they had an
otherwise incomplete chart.
• missing vital statistics (i.e. height and weight),
• 235 total charts reviewed,
– 60 no semen analysis or outside lab.
– 63 patients had either missing vital statistics or a
missing questionnaire
– This left a total of 112 patients with valid data to be
considered.
Results
The BMI groups were statistically similar as far as demographic
characteristics and confounding variables
Background Variables
70
60
Percent
50
40
Group 1
30
Group 2
20
Group 3
10
33
)
)
(1
lp
ro
b.
(
n
To
xi
ed
ic
a
ge
ry
(1
4)
M
U
G
U
G
Su
r
al
y
om
an
SD
(7
(8
)
)
1)
(6
Al
c
3)
(2
(8
To
b
ch
Ps
y
v.
Pr
eg
(3
8)
)
0
Pr
e
•
Group 1 = normal BMI; Group 2 = overweight; Group 3 = obese
Results
• There was no statistically significant difference
between the semen parameters of all three BMI
groups.
Variable
Morph. (%)
Vol (mL)
Motility (%forward)
Agg (% with)
Conc. (mil./mL)
norm value
>30
>2
>50
none
>20
BMI Groups (means)
1(N=24) 2(N=43) 3(N=45) P value
27.6
34.1
28.1
0.083
3.6
3.3
3.4
0.845
42.3
52.7
46
0.06
12
7
7
0.668
136.1
87.5
64.3
0.18
25
20
15
10
5
0
Results
• slight trend towards
a
decreasing
sperm
1
2
3
concentration with increases
in BMI
BMI Groups
Trend in Concentration
160
million / mL
140
136.1
120
87.5
100
80
64.3
60
40
20
0
1
2
3
Conclusion
• In this study, overweight and obese men
did not have an increased rate of
teratozoospermia, asthenospermia, or
oligospermia.
Discussion
•
•
•
•
Inconsistencies
Small sample size
Kort and data interpretation
Change the normal hormonal milieu, addressed
by Jensen study.
• Sertoli cell function, increased aromatase, role of
leptin
• Aggerholm study: altered hormones not
correlated with semen abnormalities in
overweight men (25.1-30.0 kg/m2), slightly
decreased sperm concentration in overweight
but not in obese
Future Studies
• What affects morphology specifically?
–
–
–
–
Hormones
Result of secondary disease, i.e.. Diabetes
Genetic mutations
Weight loss surgery and other interventions
• Overall, there is no doubt that increases in BMI
have a detrimental effect on male fertility, but a
satisfactory explanation of the mechanism for
this phenomenon has yet to be given.
References
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Ref. cont.
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