The impact of metabolically healthy obesity in primary infertile men: Results from a cross‐sectional study

Abstract

Background A number of studies showed that obesity may negatively impact on sperm quality and consequently couple's fertility. Recently, specific attention was given to a clinical condition known as metabolically healthy obesity (MHO). Objectives To evaluate the effects of MHO on semen and hormonal parameters of men presenting for primary couple's infertility associated with pure male factor infertility (MFI). Materials and methods Data from a homogenous cohort of 512 white‐European primary infertile men belonging to couples with pure MFI have been cross‐sectionally analyzed. Semen analysis was based on 2010 WHO reference criteria. Patients were segregated into eugonadal, secondary hypogonadal, primary hypogonadal, and compensated hypogonadal. The Harmonized International Diabetes Federation criteria were used to define metabolic syndrome (MetS). Based on BMI and MetS, patients were further segregated into the following: (a) metabolically healthy non‐obese (MHNO); (b) metabolically unhealthy non‐obese (MUNO) (c) metabolically healthy obesity (MHO); and, (d) metabolically unhealthy obesity (MUHO). Main outcome measures were the prevalence of MHO and the impact of MHO on semen and hormonal parameters in this cohort of MFI primary infertile men. Results Overall, MHNO, MUNO, MHO, and MUHO were found in 462 (90%), 13 (2.5%), 27 (5.2%), and 10 (1.9%) men, respectively. MHO patients had lower total testosterone and SHBG levels (all P < .05) but higher E2 values (P < .005) compared with MHNO men. Groups did not differ in terms of semen parameters. At multivariable logistic regression, analysis MHO was associated with an increased risk of primary and secondary hypogonadism (all P ≤ .02) compared with MHNO, after accounting for age and comorbid conditions. Discussion and conclusions Metabolically healthy obesity is threefold more prevalent than unhealthy obesity in primary infertile men. Despite semen parameters are comparable among groups, MHO patients show worse endocrine parameters and a higher risk of primary and secondary hypogonadism compared with metabolically healthy normal infertile men.

Association between obesity-associated markers and semen quality parameters and serum reproductive hormones in Chinese infertile men

“…This study highlights the importance of weight control to patients with MUHO. Based on this classification, the authors found no significant effect of metabolic condition on semen parameters as compared with MHNO [39]. In our study, we made the classification based on BMI by both WHO and Chinese classifications.…”

“…Previous studies observed an inverse relationship between overweight/obesity and androgen levels [1,40]. When taking metabolic condition into consideration, Cazzaniga W et al found that MHO had lower TT but higher E2 circulating values [39]. In our study, we found that overweight and obese group exhibited a significantly lower level of TT and HDL-C than that in normal group, while higher level of P, E2, E2/TT, TC, LDL-C and TG than that in normal group.…”

“…Some studies indicated that higher BMI levels affect semen quality parameters including semen volume, motile sperm and sperm concentration [33][34][35][36], while many studies showed no association between BMI and semen quality parameters [37,38]. In one recent cross-sectional study, based on a strict classification on weight and analysis of the effects of metabolically healthy obesity (MHO) on male fertility, Cazzaniga W et al found that patients with metabolically unhealthy obesity (MUHO) were more frequently to have secondary and compensated hypogonadism compared with patients with metabolically healthy non-obese (MHNO) [39]. This study highlights the importance of weight control to patients with MUHO.…”

“…However, limitations existed in our study. Compared with previous studies [1,13,39], our single center-based study recruited a relatively small, homogeneous, sameethnicity cohort of infertile men, which might lead to selection biases. Therefore, further studies across multiple centers and different ethnicities are needed to corroborate our findings…”

Triglycerides/Glucose Index Is Associated with Sperm Parameters and Sperm DNA Fragmentation in Primary Infertile Men: A Cross-Sectional Study

“…Among the treatable causes of male infertility, semen infections, smoking habits, alcohol consumption, abnormal DNA methylation, bacterial and viral infections, and recreational substance use have been consistently associated with impaired sperm quality [4][5][6][7]. Furthermore, metabolic disorders such as prediabetes, diabetes mellitus (DM), and metabolic syndrome (MetS) are commonly found in infertile men [8][9][10]. In this context, DM and insulin resistance (IR) have been observed to negatively affect sperm quality and hormonal values, thus contributing to MFI [11].…”