Secondary male factor infertility after Roux-en-Y gastric bypass for morbid obesity: Case report

Abstract

Surgical treatments such as the Roux-en-Y gastric bypass operation result in the successful treatment of morbid obesity; however, this type of operation may cause long-term side effects due to the reduced absorption of nutrients. Here, we present data suggesting that this operation can result in secondary infertility in males. Six healthy, previously fertile male subjects presented in our centre for secondary infertility after a Roux-en-Y gastric bypass operation for morbid obesity. Reproductive function was assessed with a series of spermiograms, and by testicular biopsy. Secondary azoospermy with complete spermatogenic arrest was diagnosed. The results suggest that weight reduction surgery may cause reproductive dysfunction.

Overweight Men: clinical pregnancy after ART is decreased in IVF but not in ICSI cycles

“…Conversely, the hazards of obesity on male fertility are rarely acknowledged and the impact of weight reduction on male reproduction remains poorly understood. With the exception of one case report of unexplained spermatogenic arrest after bariatric surgery-induced weight loss [39], there is a paucity of studies assessing the impact of weight loss on male reproductive success, assisted or unassisted. Obese men showed an overall improved reproductive hormone profile, with an increase in SHBG and testosterone and decrease in estrogen after bariatric surgery induced weight loss [40,41].…”

Obesity and reproduction: a committee opinion

“…Of more concern, case reports of obese men undergoing bariatric surgery have shown a worsening of their semen parameters, perhaps from postoperative nutritional deficiencies, causing secondary infertility from spermatogenic arrest (164,165) and impaired IVF pregnancy outcome (166). In another case series, however, semen parameters of three obese men remained stable up to 1 year following bariatric surgery (167).…”

Weight loss by bariatric surgery and subsequent fertility

“…Secondary azoospermy with complete spermatogenic arrest was diagnosed in all of them. These data suggested that this operation could result in secondary infertility in males (15). A study from Israel by Sheiner et al (16) showed that 21.4% of 28 women who had bariatric surgery needed fertility treatments versus only 5.5% of 7,986 controls; odds ratio 4.7, 95% confidence interval 1.9 -11.6 (both cases and controls had gestational diabetes) ascribing higher rates of infertility to the bariatric surgery.…”

“…The literature review revealed that relatively limited data exist on the subject. Although male fertility is beyond the scope of the paper, it is worthy to note that a case series of six healthy previously fertile male subjects showed that surgical treatments with Roux-en-Y gastric bypass operation was associated with long-term side effects in fertility status, probably due to the reduced absorption of nutrients (15). Those subjects presented for secondary infertility after a Roux-en-Y gastric bypass operation for morbid obesity (weight loss of 60 -80 kg), and reproductive function was assessed with a series of spermiograms and by testicular biopsy.…”