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


Finally,


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.


Conclusion


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.


Carlsen E, Giwercman A, Keiding N, Skakkebaek NE, Evidence for decreasing quality of semen during past 50 years, Br Med J, 1992;305(6854):609–13.


Irvine S, Cawood E, Richardson D, et al., Evidence of deteriorating semen quality in the United Kingdom: birth cohort study in 577 men in Scotland over 11 years, Br Med J, 1996;312(7029):467–71.


3. 4.


van Waeleghem K, De Clercq N, Vermeulen L, et al., Deterioration of sperm quality in young healthy Belgian men, Hum Reprod, 1996;11(2):325–9.


Swan SH, Elkin EP, Fenster L, The question of declining sperm density revisited: an analysis of 101 studies published 1934–1996, Environ Health Perspect, 2000;108(10):961–6.


5. 6. 7. 8. 9. 10.


Martini AC, Tissera A, Estofan D, et al., Overweight and seminal quality: a study of 794 patients, Fertil Steril, 2010 (Epub ahead of print).


Hammoud AO, Gibson M, Peterson CM, et al., Impact of male obesity on infertility: a critical review of the current literature, Fertil Steril, 2008;90(4):897–904.


Hedley AA, Ogden CL, Johnson CL, et al., Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002, JAMA, 2004;291(23):2847–50.


Mokdad AH, Serdula MK, Dietz WH, et al., The spread of the obesity epidemic in the United States, 1991–1998, JAMA, 1999;282(16):1519–22.


Du Plessis SS, Cabler S, McAlister DA, et al., The effect of obesity on sperm disorders and male infertility, Nat Rev Urol, 2010;7:153–61.


Booth ML, Hunter C, Gore CJ, et al., The relationship between body mass index and waist circumference: implications for estimates of the population prevalence of overweight, Int J Obes Relat Metab Disord, 2000;24(8):


15. 16. 17. 18. 19. 20. 1058–61. 11.


Huxley R, Mendis S, Zheleznyakov E, et al., Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk—a review of the literature, Eur J Clin Nutr, 64(1):16–22.


12.


Akpinar E, Bashan I, Bozdemir N, Saatci E, Which is the best anthropometric technique to identify obesity: body mass index, waist circumference or waist-hip ratio?, Coll Antropol, 2007;31(2):387–93.


13.


Isidori AM, Caprio M, Strollo F, et al., Leptin and androgens in male obesity: evidence for leptin contribution to reduced androgen levels, J Clin Endocrinol Metab, 1999;84(10):3673–80.


14.


WHO, Prevalence of overweight, obesity and extreme obesity among adults: United States, trends 1976–80 through 2005–2006, 2006. Available at:


apps.who.int/infobase/reportviewer.aspx?rptcode=ALL&; uncode=840&dm=5&surveycode=102913a1


Popkin BM, Recent dynamics suggest selected countries catching up to US obesity, Am J Clin Nutr, 91(1):284S–8S.


Fedorcsak P, Dale PO, Storeng R, et al., Impact of overweight and underweight on assisted reproduction treatment, Hum Reprod, 2004;19(11):2523–8.


Pasquali R, Pelusi C, Genghini S, et al., Obesity and reproductive disorders in women, Hum Reprod Update, 2003;9(4):359–72.


Sallmen M, Sandler DP, Hoppin JA, et al., Reduced fertility among overweight and obese men, Epidemiology, 2006;17(5):520–23.


Nguyen RH, Wilcox AJ, Skjaerven R, Baird DD, Men’s body mass index and infertility, Hum Reprod, 2007;22(9):2488–93.


Ramlau-Hansen CH, Thulstrup AM, Nohr EA, et al., 29. 26. 27. 28. 21.


Subfecundity in overweight and obese couples, Hum Reprod, 2007;22(6):1634–7.


Jensen TK, Andersson AM, Jorgensen N, et al., Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men, Fertil Steril, 2004;82(4):863–70.


22. 23. 24. 25.


Strain GW, Zumoff B, Kream J, et al., Mild hypogonadotropic hypogonadism in obese men, Metabolism, 1982;31(9):871–5.


Pauli EM, Legro RS, Demers LM, et al., Diminished paternity and gonadal function with increasing obesity in men, Fertil Steril, 2008;90(2):346–51.


Hammoud AO, Wilde N, Gibson M, et al., Male obesity and alteration in sperm parameters, Fertil Steril, 2008;90(6):2222–5.


Smit M, Romijn JC, Wildhagen MF, et al., Sperm chromatin structure is associated with the quality of spermatogenesis in infertile patients, Fertil Steril, 2009 (Epub ahead of print).


Kort HI, Massey JB, Elsner CW, et al., Impact of body mass index values on sperm quantity and quality, J Androl, 2006;27(3):450–52.


Evenson D, Wixon R, Meta-analysis of sperm DNA fragmentation using the sperm chromatin structure assay, Reprod Biomed Online, 2006;12(4):466–72.


Traish AM, Feeley RJ, Guay A, Mechanisms of obesity and related pathologies: androgen deficiency and endothelial dysfunction may be the link between obesity and erectile dysfunction, FEBS J, 2009;276(20):5755–67.


Cheng JY, Ng EM, Body mass index, physical activity and erectile dysfunction: an U-shaped relationship from population-based study, Int J Obes (Lond), 2007;31(10): 1571–8.


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


63


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84