Fertility Fears – Fate of the Fat
oestrogen levels, normalising LH and FSH levels and restoring spermatogenesis and fertility.38,65 treat ED in the obese patient.66,67
Various drugs are also available to
Alternative surgical options may include scrotal lipectomy to reduce increased scrotal temperature and genital heat stress.55
most successful at correcting hormonal imbalances. However, obesity treatment and therapeutic interventions need to be studied more extensively before they can be offered routinely. n
assisted reproductive techniques such as in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) remain viable options to treat male-factor infertility, despite morbid obesity in the male being associated with lower pregnancy rates in females after treatment.68
In order to obtain the best treatment outcome and prognosis, it is advisable to motivate the morbidly obese to join support groups and undergo counselling/cognitive behaviour therapy before, during and after any of these treatments. For some patients, lifelong support may be needed.
The obesity pandemic is on the increase globally, and its associated co-morbidities are seriously affecting patients, nations and the global village as a whole. Data show that obesity is associated with reduced male fertility and fecundity. Enough evidence exists to classify obesity as a cause of male subfertility. The effect of obesity on male fertility seems to be modest, but its prevalence is on the increase, thereby making it extremely important and topical. The reasons for fertility decline in obese men are multifactorial as various endocrine and hormonal changes are responsible for the manifestations of altered sperm parameters and other possible infertility-associated effects. Dysregulation of the HPG axis might explain most of the changes seen in sperm parameters. Another potential cause of male infertility not discussed in this review is the accumulation of toxic substances in fatty tissue.6,69
A variety of treatment options are available, with weight reduction being the 1. 2.
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Ashok Agarwal is a Professor in the Lerner College of Medicine at Case Western Reserve University and Director of the Center for Reproductive Medicine and the Clinical Andrology Laboratory at The Cleveland Clinic in Ohio. He has published over 450 scientific articles and reviews and is currently editing eight textbooks. His research programme is known internationally for its focus on cutting-edge disease-oriented work in the field of human reproduction.
Stefan S du Plessis is Head of the Division of Medical Physiology and an Associate Professor in the Faculty of Health Sciences at Stellenbosch University in South Africa. He heads the Sperm Laboratory in the Department of Biomedical Sciences. His research interests are in the fields of oxidative stress as well as elucidating the roles of obesity, insulin, leptin, glucose and GLUT8 on sperm parameters and function.
Stephanie Cabler is a first year medical student at Case Western School of Medicine in Cleveland. She was a research intern at the Cleveland Clinic’s Center for Reproductive Medicine from June to July 2009. She graduated with a BS science–business major from the University of Notre Dame du Lac in South Bend in May 2010.
Edmund S Sabanegh, Jr, is Chairman of the Department of Urology and Director of the Center for Male Fertility for the Glickman Urological and Kidney Institute at the Cleveland Clinic. In addition, he is the Program Director for the Male Infertility Fellowship, leading one of the few male infertility Fellowship programmes in the US, which combines basic research with extensive clinical experience.
EUROPEAN UROLOGICAL REVIEW
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