How Obesity Affects Male Fertility

Recent studies appear to show a higher prevalence of male infertility in those with morbid obesity.

Obesity defined as a body mass index (BMI) greater than 40.   As the obesity epidemic continues, the US may be seeing more couples present with fertility issues.

BMI is a ratio of weight over height.  Ideally, BMI should be less than 25 for good general health.   Being overweight or obese is generally considered to occur with a BMI of 30.  Once a patient’s BMI reaches 40, he is considered to be “morbidly” obese.

Morbid obesity is strongly associated with co morbid conditions.

  In particular diabetes and hypertension occur with a much higher incidence in the obese population.  Furthermore, both of these conditions are often co factors in the eventual development of kidney disease or renal insufficiency as well as heart disease, osteoporosis and other conditions.   Many systemic illnesses, in and of themselves raise the risk of fertility issues.

Some people with morbid obesity are known to have an entity called metabolic syndrome

which is a cluster of signs and symptoms including glucose intolerance, hypogonadism or low testosterone, centripetal obesity and sleep apnea.   Sleep apnea can perpetuate metabolic syndrome as people who are sleep deprived tend to snack more during the day and do less physical activity. 

Fat cells contain an enzyme called aromatase that converts testosterone to estrogen

It is common in this population to find a relative estrogen excess, another potential cofactor in male infertility. Therefore, it is not surprising to find that people who are significantly overweight may be at more risk for fertility issues and findings of abnormalities on semen analysis.   

So, what can be done?

It boils down to adopting a healthier lifestyle. Eat a sensible diet.  Control calorie intake.  Shift away from simple sugars to a diet with a greater proportion of vegetable sources for fats and proteins.  Consider a daily multivitamin.   Incorporate exercise several times in your weekly regimen.    If sleep apnea is suspected, have your doctor order a sleep study.   Limit alcohol and refrain from smoking.   Sensible weight loss is often the most important step in correcting metabolic syndrome and reducing the negative health effects of obesity. 

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