Bariatric Surgery Impact on Reproductive Hormones, Semen Analysis, and Sperm DNA Fragmentation in Men with Severe Obesity: Prospective Study

Wood, Guilherme Jacom Abdulmassih; Tiseo, Bruno Camargo; Paluello, Davi V.; Martin, H.; Santo, Marco Aurélio; Nahas, William Carlos; Srougi, Miguel; Cocuzza, Marcello

doi:10.1007/s11695-020-04851-3

Cited by 33 publications

(31 citation statements)

References 61 publications

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“…Moreover, they demonstrated that patients who experienced greater weight loss had greater postoperative changes in TT levels, in a clear “dose-dependent” effect. 43 …”

Section: Discussionmentioning

confidence: 99%

Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile

et al. 2021

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Introduction: Male obesity has a negative correlation with plasma testosterone (T) levels and sexual function (SF).Aim: To evaluate the effect of weight loss through bariatric surgery (BS) on SF, low T symptoms, and hormonal profiles in obese men. Methods: Thirty-three men who underwent BS participated in this cohort study. Before surgery, all participants underwent clinical examinations, including anthropometric, lipid, glycemic, and hormonal evaluations. SF was evaluated using the International Index of Erectile Function (IIEF) questionnaire; low T symptoms were evaluated using the Aging Males' Symptoms (AMS) and Androgen Deficiency in the Aging Male (ADAM) questionnaires. The participants were reevaluated 6 months post-surgery. Main outcome measures: Sex hormone profile, SF, and low T symptoms Results: After BS, a significant increase in mean total T (201 § 111−548 § 190 ng/dL, P < .001), free T (5.8 § 2.8−9.3 § 3.4 ng/dL, P < .001), bioavailable T (110.3 § 57.8−198.6 § 74.3 ng/dL, P < .001), and sexual hormone-binding globulin (19.8 § 13.7−54.6 § 23.2 nmol/L, P < .001) levels. There was a significant decrease in estradiol (64.6 § 27.4−29.2 § 20.0 [pg/mL], P < .001). SF significantly improved. The total IIEF score increased 5.2 points (62.3 § 7.4−67.5 § 7.4, P = .004), erectile function subdomain increased 2.4 points (25.7 § 4.1−28.1 § 3.9, P = .011), desire subdomain increased 1.0 points (8.3 § 1.5−9.3 § 1.6, P = .006), and intercourse satisfaction subdomain increased 1.2 points (11.4 § 1.9−12.6 § 1.8, P = .012). Post-surgery, a 44% reduction (P = .001) was observed in the positive ADAM questionnaire, and improvements in all domains of the AMS questionnaire were found (P < .001). Conclusion: Significant weight loss through BS improves erectile function, hormonal profile, and symptoms of T deficiency.

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“…Moreover, they demonstrated that patients who experienced greater weight loss had greater postoperative changes in TT levels, in a clear “dose-dependent” effect. 43 …”

Section: Discussionmentioning

confidence: 99%

Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile

et al. 2021

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“…Although a positive association between BMI and subfertility has been reported in observational studies ( Ramlau-Hansen et al , 2007 ; van der Steeg et al , 2008 ; Pinborg et al , 2011 ; Campbell et al , 2015 ; Mushtaq et al , 2018 ), an improvement in assisted reproduction success has not been observed in all randomized controlled trials of weight loss after lifestyle modifications ( Mutsaerts et al , 2016 ; Best et al , 2017 ; Einarsson et al , 2017 ; Norman and Mol, 2018 ) or bariatric surgery ( Grzegorczyk-Martin et al , 2020 ; Wood et al , 2020 ). Our data suggest that increases in BMI from 23 and 25 kg/m 2 in women and men, respectively, are linked to greater odds of subfertility.…”

Section: Discussionmentioning

confidence: 99%

“…Moderate weight loss has only been shown to increase the rate of live births in spontaneous conceived pregnancies in one of these trials ( Einarsson et al , 2017 ) and particularly among women with anovulation due to polycystic ovary syndrome ( Norman and Mol, 2018 ). Finally, although massive weight loss after bariatric surgery is linked to normalization of hormonal axes in women and men ( Lee et al , 2019 ; Snoek et al , 2021 ), improvement in some surrogate indicators of fertility (more regular menstrual cycles in women, less erectile dysfunction in men) ( Lee et al , 2019 ; Snoek et al , 2021 ) and a decrease in subfertility risk in women ( Snoek et al , 2021 ), its effects on fertility have been little evaluated in intervention trials in women ( Grzegorczyk-Martin et al , 2020 ) and it has been related to a reduction in sperm quality in men ( Wood et al , 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Body mass index and subfertility: multivariable regression and Mendelian randomization analyses in the Norwegian Mother, Father and Child Cohort Study

et al. 2021

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STUDY QUESTION What is the association between BMI and subfertility? SUMMARY ANSWER We observed a J-shaped relationship between BMI and subfertility in both sexes, when using both a standard multivariable regression and Mendelian randomization (MR) analysis. WHAT IS KNOWN ALREADY High BMI in both women and men is associated with subfertility in observational studies and this relationship is further substantiated by a few small randomized controlled trials of weight reduction and success of assisted reproduction. Women with low BMI also have lower conception rates with assisted reproduction technologies. STUDY DESIGN, SIZE, DURATION Cohort study (the Norwegian Mother, Father and Child Cohort Study), 28 341 women and 26 252 men, recruited from all over Norway between 1999 and 2008. PARTICIPANTS/MATERIALS, SETTING, METHODS Women (average age 30, average BMI 23.1 kg/m2) and men (average age 33, average BMI 25.5 kg/m2) had available genotype data and provided self-reported information on time-to-pregnancy and BMI. A total of 10% of couples were subfertile (time-to-pregnancy ≥12 months). MAIN RESULTS AND THE ROLE OF CHANCE Our findings support a J-shaped association between BMI and subfertility in both sexes using multivariable logistic regression models. Non-linear MR validated this relationship. A 1 kg/m2 greater genetically predicted BMI was linked to 18% greater odds of subfertility (95% CI 5% to 31%) in obese women (≥30.0 kg/m2) and 15% lower odds of subfertility (−24% to −2%) in women with BMI <20.0 kg/m2. A 1 kg/m2 higher genetically predicted BMI was linked to 26% greater odds of subfertility (8–48%) among obese men. Low genetically predicted BMI values were also related to greater subfertility risk in men at the lower end of the BMI distribution. A genetically predicted BMI of 23 and 25 kg/m2 was linked to the lowest subfertility risk in women and men, respectively. LIMITATIONS, REASONS FOR CAUTION The main limitations of our study were that we did not know whether the subfertility was driven by the women, men or both; the exclusive consideration of individuals of northern European ancestry; and the limited amount of participants with obesity or BMI values <20.0 kg/m2. WIDER IMPLICATIONS OF THE FINDINGS Our results support a causal effect of obesity on subfertility in women and men. Our findings also expand the current evidence by indicating that individuals with BMI values <20 kg/m2 may have an increased risk of subfertility. These results suggest that BMI values between 20 and 25 kg/m2 are optimal for a minimal risk of subfertility. STUDY FUNDING/COMPETING INTEREST(S) The MoBa Cohort Study is supported by the Norwegian Ministry of Health and Care Services and the Norwegian Ministry of Education and Research. This project received funding from the European Research Council under the European Union’s Horizon 2020 research and innovation program (grant agreement No 947684). It was also partly supported by the Research Council of Norway through its Centres of Excellence funding scheme, project number 262700. Open Access funding was provided by the Folkehelseinstituttet/Norwegian Institute of Public Health. D.A.L. is a UK National Institute for Health Research Senior Investigator (NF-SI-0611-10196) and is supported by the US National Institutes of Health (R01 DK10324) and a European Research Council Advanced Grant (DevelopObese; 669545). The funders had no role in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. D.A.L. receives (or has received in the last 10 years) research support from National and International government and charitable bodies, Roche Diagnostics and Medtronic for research unrelated to the current work. The rest of the authors declare that no competing interests exist. TRIAL REGISTRATION NUMBER N/A.

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“…Most previous studies have shown beneficial effects of bariatric surgery on infertility and increased sperm count [ 9 - 12 ]. Only a few case series have reported decreased sperm count and azoospermia after bariatric surgery [ 13 ]. One study included 42 men with obesity (body mass index over 40 kg/m²).…”

Section: Discussionmentioning

confidence: 99%

“…However, their sperm count decreased dramatically following surgery (122.8 million to 17.0 million). Two patients (11%) no longer produced sperm following surgery (azoospermia) [ 13 ]. In another case series, six patients were reported to experience azoospermia, presenting secondary infertility after Roux-en-Y gastric bypass interventions [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Decrease in Sperm Count After Bariatric Surgery: Case Reports

Razzaq

Soomro

Siddiq

et al. 2021

Cureus

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Morbid obesity is associated with a large number of complications, including infertility; weight loss can help to improve fertility and increase the number of sperm in males. However, two of our patients developed azoospermia after bariatric surgery for weight reduction. A 30-year-old male presented to the outpatient department (OPD) with a BMI of 81.2 kg/m 2 (258 kg) with no known co-morbidities. The patient had a normal sex life and one child. After bariatric surgery, he noticed a change in the consistency of his semen and azoospermia. In the second case, a 48-year-old man presented to the OPD with a BMI of 52 kg/m 2 (189 kg) with no known co-morbidities. He had three children. He underwent bariatric surgery for weight loss and, after one year, he developed azoospermia. Bariatric surgery is a lifesaving procedure for morbidly obese patients and helps in restoring normal daily activities. This weight reduction surgery helps in decreasing blood pressure, increasing glycemic control and improving sexual activity. However, bariatric surgery may be followed by a further decline in semen parameters, resulting in azoospermia and severe oligoasthenoteratozoospermia. This is caused by the combined effects of two different processes: 1) the subduing of the negative effects of obesity, and 2) a deficiency of nutrients along with the release of some harmful substances. Bariatric surgery patients should be informed about the risk of complications and about the possibility for cryopreservation of sperm. In rare cases, bariatric surgery can result in a decrease in sperm count and infertility in males.

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Bariatric Surgery Impact on Reproductive Hormones, Semen Analysis, and Sperm DNA Fragmentation in Men with Severe Obesity: Prospective Study

Cited by 33 publications

References 61 publications

Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile

Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile

Body mass index and subfertility: multivariable regression and Mendelian randomization analyses in the Norwegian Mother, Father and Child Cohort Study

Decrease in Sperm Count After Bariatric Surgery: Case Reports

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