Obesity in men: does it affect fertility?

Abstract

It is usual that in the context of seeking pregnancy or during evaluations in a case of infertility, all attention is focused on the pathologies and risk factors of the woman. We forget about the impact of male habits and pathologies and how this impacts the couple's fertility. However, in the evaluation of the infertile couple, a male factor of infertility is detected in 50% of the cases.

Evaluation of the male and treatment in cases of infertility should not be delayed, both members of the infertile couple should be approached together. In cases of seeking pregnancy, without evidence of infertility, it would also be appropriate to advise on healthy habits and treat pathologies, such as obesity, which can affect semen quality.

Obesity can affect male fertility in different ways:

• Increasing oxidative stress.
• Affecting hypothalamic GnRH pulsatility.
• Altering the function of the blood testis barrier.
• Determining less sperm capacitation.

This determines alterations in the quality of the spermogram, sperm DNA damage and subfertility. The treatment of obesity in men improves all these parameters, either through diet and exercise or through pharmacological treatments.

A separate consideration is bariatric surgery in men with a desire for fertility, since there have been reports of cases of impaired sperm count or even azoospermia after it, more evidence is required. The same occurs with metformin treatment in men with obesity and diabetes, where an increased risk of genitourinary malformations has been shown in children born to couples where the father received metformin during the preconception period.