Mechanisms of Obesity-induced Male Infertility

Karen P Phillips; Nongnuj Tanphaichitr


Expert Rev Endocrinol Metab. 2010;5(2):229-251. 

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Expert Commentary

Clinical knowledge in the identification and treatment of obesity-induced male infertility is still lacking. The assessment of male infertility relies on numbers of sperm and morphological abnormalities, with little functional analysis beyond estimates of motility. Subfertility is undoubtedly underestimated, simply because clinics lack tools to provide functional semen analysis, including sperm–egg binding and acrosome/capacitation assays. Screening for insulin resistance and hypogonadism should be considered as part of infertility diagnostics for overweight and obese male patients. As the age of onset for Type 2 diabetes is declining, men under the age of 40 years should be included in this screening. BMI and waist:hip ratio data should be collected for male infertility patients along with standard endocrine profiles to identify who would benefit from weight loss or treatment with hormone therapies. Medications used to treat Type 2 diabetes (sulfonylureas, biguanides, e.g., metformin and thiazolidinediones) have not been well examined for their impacts on male fertility. Information on exposure to endocrine disrupters and other environmental contaminants should be gathered by occupation and lifestyle questionnaires and it may help explain idiopathic forms of male infertility. In general, it is anticipated that the obese man is likely to exhibit hypogonadism and is hyperestrogenic, conditions that would cause the greatest risk to male infertility.


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