Abnormalities of Reproductive Function in Male Obesity Before and After Bariatric Surgery—A Comprehensive Review

Abstract

Young males represent one of the populations with the steepest increases in the incidence of obesity. They are also prone to significant derangements in sexual health and fertility. Despite a growing number of reports about female reproductive health, in the setting of bariatric surgery, males have received much less attention. In the current review of reproductive abnormalities in severe obese males before and after bariatric surgery, erectile function, hypothalamic-pituitary-gonadal axis status, sex hormones, semen quality, fertility and assisted reproductive techniques, along with analysis of adipokines, gut hormones, and environmental factors are addressed. Available evidence about weight loss benefits, both medical and surgical, are highlighted, along with perspectives for future investigations, which may be relevant for the patient, for the couple, and for the community alike.

Cross-sectional study of male sexual function in bariatric patients.

“…In the case of men, research proved impaired sexual function in overweight and obese subjects [3]. As a result of the presence of central obesity, hypertension, diabetes, insulin resistance and hormone disorders, this population is more prone to experience erectile dysfunction (ED) [4, 5]. Erectile dysfunction is defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse.…”

“…The procedures are equally effective in the case of weight loss, but LRYGB seems to be more effective in resolving comorbidities [7, 8]. The weight loss after bariatric surgery leads to the normalization of hormone levels and resolution of comorbidities, especially hypertension and diabetes [5]. In the majority of patients, there is a reduction of antihypertensive and diabetic drug use in the post-operative period [13].…”

Seminal but not Serum Levels of Holotranscobalamin are Altered in Morbid Obesity and Correlate with Semen Quality: A Pilot Single Centre Study

“…It is known that morbid obesity is associated with sub-fertility [16,17,18,19], reduced semen quality [19,20,21,22], impaired sperm acrosome reaction [23], and sperm fatty acid composition and functions [24,25]. In particular, a large population study performed in men ( n = 4,860), classified according to their BMI (underweight: n = 45, normal weight: n = 1,330, overweight: n = 2,493, obese: n = 926, and morbidly obese: n = 57), has shown that at both extremes of BMI (underweight and morbidly obese subjects), semen parameters were significantly worse and associated with lower sperm epididymal maturation compared to the other BMI classes [22].…”

Review of post bariatric surgery effects on common genitourinary physiology

“…Obesity is a public health concern with increased prevalence in the past two decades ( 1 ). The highest peak is in women and men aged between 20 and 40 years ( 2 ). In adults aged 20 years and above, it is defined as body mass index (BMI) equal to or greater than 30 kg/m 2 ( 3 ).…”

“…It can even affect reproductive functions in both sexes and lead to pregnancy/perinatal or offspring adverse effects ( 1 ). In men, it may cause oligozoospermia and asthenozoospermia ( 1 ), erectile dysfunction ( 2 ) and subfertility ( 6 ). The estimated annual medical costs of illness pertinent to adult obesity exceed 200 US billion ( 5 ).…”