Abstract
Obesity in men is associated with infertility in numerous studies, and the temporal
trend for a decline in semen parameters parallels the increasing prevalence of obesity
in the developed world. In addition to impaired semen quality, fertility among obese
men may be affected by decreased libido and erectile dysfunction. This spectrum of
expression of hypogonadism among obese men originates from multiple interacting factors
including reduced levels of gonadotropins and testosterone, altered androgen-to-estrogen
ratios, insulin resistance, and sleep apnea. No evidence-based treatment that increases
the likelihood of pregnancy for the infertility associated with male obesity has been
demonstrated to date. Interventions associated with improvement of intermediate outcomes
that include the endocrine profile, semen parameters, and sexual function may be appropriately
selected based on history, physical findings, as well as endocrine and metabolic evaluation.
Among these interventions are weight loss through lifestyle change, relief from sleep
apnea, use of aromatase inhibitors, gonadotropin administration, phosphodiesterase
inhibitors, and insulin-sensitizing agents.
Keywords
male infertility - overweight - BMI - semen parameters - treatment - reproductive
function
