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 in parallel to obesity. Obesity in men is associated with infertility in numerous studies.
Materials and methods
In this review article, electronic searches were undertaken in PubMed and Google Scholar, up to date since 2014.
The prime hormonal defect in obese men is hypotestosteronemia, which results in impaired spermatogenesis leading to poor fecundability. In massively obese individuals, reduced spermatogenesis associated with severe hypotestosteronemia may affect infertility. In addition to impaired semen quality, fertility among obese men may be affected by sexual dysfunction, endocrinopathy, aromatization activity, psychological and thermal effects, sleep apnea, leptin and minor toxins and possibly the inflammatory and obstructive elements of epididymitis pathology. The frequency of erectile dysfunction increases with increasing body mass index. 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.
Studies have shown that most mechanisms accounting for reduced fertility potentials in overweight men are reversible. Treatment of obesity may improve androgen imbalance and erectile dysfunction, the major causes of infertility in obese men. Treatments are available for not only infertility related to obesity, but also as a treatment for the other comorbidities arising from obesity. Natural weight loss, as well as 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 male.