Semin Reprod Med 2012; 30(06): 486-495
DOI: 10.1055/s-0032-1328877
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Obesity and Male Infertility: A Practical Approach

Ahmad O. Hammoud
1   Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology
,
A. Wayne Meikle
2   Endocrinology/Diabetes Research Department of Medicine
,
Leonardo Oliveira Reis
1   Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology
4   Department of Surgery (Urology), School of Medical Sciences, University of Campinas, UNICAMP, Brazil
,
Mark Gibson
1   Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology
,
C. Matthew Peterson
1   Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology
,
Douglas T. Carrell
1   Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology
3   Andrology and IVF laboratories, Department of Surgery (Urology) and Physiology, University of Utah School of Medicine, Salt Lake City, Utah
› Author Affiliations
Further Information

Publication History

Publication Date:
16 October 2012 (online)

Abstract

Obesity in men is associated with infertility in numerous studies, and the temporal trend for a decline in semen parameters parallels the increasing prevalence of obesity in the developed world. In addition to impaired semen quality, fertility among obese men may be affected by decreased libido and erectile dysfunction. This spectrum of expression of hypogonadism among obese men originates from multiple interacting factors including reduced levels of gonadotropins and testosterone, altered androgen-to-estrogen ratios, insulin resistance, and sleep apnea. No evidence-based treatment that increases the likelihood of pregnancy for the infertility associated with male obesity has been demonstrated to date. Interventions associated with improvement of intermediate outcomes that include the endocrine profile, semen parameters, and sexual function may be appropriately selected based on history, physical findings, as well as endocrine and metabolic evaluation. Among these interventions are weight loss through lifestyle change, relief from sleep apnea, use of aromatase inhibitors, gonadotropin administration, phosphodiesterase inhibitors, and insulin-sensitizing agents.