1. Dr. Sharda Jain
Dr. Abhishek Singh Parihar
Dr. Yogesh Agarwala Bariatric
Surgeon
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar
Obesity Reduces
Fertility In Men

2. Content
Epidemic of obesity
Obesity in India & it bad effects
is obese man at risk of infertility ?
What is the changes in semen ?
What is the spectrum ?
What is the mechanism ?
What we can do about it ?
ART in obesity
Place of Beriatric surgery

3. Available on slideshare.net
Obesity Reduces
Fertility In Men

4. OBESITY
“AN EMERGING MENACE”
1. > 1 Billion overweight
2. > 300 Million – Obese
3. Obesity in men leading cause
of morbidity & mortality
secondary to tobacco
W
H
O

5. PREVALENCE OF OBESITY
is on increase!! ( 1986 – 2000 )
1. BMI > 30 kg / m2
- doubled
2. Morbid Obesity > 40 kg /m2
quadrupled
3. Super Obesity > 50 kg /m2 –
five fold Increase
Buchwald et al Surg for obesity & realated
diseases(2005) 371-381

6. Obesity in Men & Women in
Reproductive Age in India
Country Male Female
India 9 12 (2000)
12 16 (2001)
Punjab 30 37.5
Gujrat 15 17
UP 16 12
Haryana 14 17

7. • BMI (Body Mass Index)
= Weight in kg / Height in M2
• Waist : Hip Ratio
Men > 0.88
Women > o.85
Quantification of Obesity

8. The measures may be even more
useful than BMI because of its
greater predictive value for future
health risk as well as ease of
measurements
Men Waist = 40” (102 cm)
Women Waist = 35” (88 cm)
National Institute of Health Rockville: national institute of health .
2000.(publication no. 00-4084)

9. BODY MASS INDEX
-2.5 in each category for
INDIANS (WHO)

10. Male Health & Obesity
Same or Different

11. Five Metabolic Abnormalities
Which effect Health Badly

12. MUO
METABOLICALY UNHEALTHY OBESITY
MUO is 2 or 2+ MHO 0-1 abnormality
MHO
METABOLICALY HEALTHY OBESITY

13. Obesity is The Root Cause of Some
of the Serious Diseases
Metabolic Disorders
• In Indians , types 2 diabetes and
hypertension has a close link to
obesity
• 60 million people suffered from
diabetes in 2012 and will exceed
100 million by 2030
• People with BMI >35.0 kg/m have
a 6-fold higher risk of diabetes

14. Obesity is The Root Cause of Some
of the Serious Disease
CARDIOVASCULAR DISEASES
– Obese men have 30% higher
risk of death , due to
– circulatory system diseases than
normal weight individuals
CANCER
•Obese men have showed higher risk of cancer
•Ostioarthritis, gall bladder disease, Asthma

15. Morbid Obesity : Takes Heavy
Toll on men’s Health
- Globally . morbid obesity is responsible for the
following co-morbidities
7-41% of cancer cases like colon, rectum,
kidney, pancreas etc
44% of diabetes cases
23%of ischemic heart disease cases
Hyptension , dyslipidemia ,asthma., osteoarthritis
gall bladder disease etc.

16. IMPACT OF OBESITY ON
LONGEVITY
• 2.5 million deaths attributed annually to
obesity
• In morbid obesity - life expectancy is
reduced by
9 yrs in women
12 yrs in men
Framingham dataFramingham data

17. OBESITY & PSYCHOSOCIAL
HEALTH in MEN
1. Poor body image
2. Social stigmatisation (‘a laughing matter’)
3. Lower education levels
4. Lower rates of marriage
5. Lower socio economic levels

18. Is obese men at risk of infertility
• An obese man is about twice
as likely to be infertile as a
normal man
Semen Count & Quality has declined all over
the world in last 4-5 decades.
Possibly this trend corresponds with Global
increase risk in obesity
Yes
Flegal et al. JAMA 2010,303,255-41

19. It is seen that
adolescent
obesity is
associated with a
threefold increase
risk of infertility
Is obese men at risk of infertility

20. Impacts
Fertility
Outcomes
Male

21. What are the changes in the semen
Indices of obese men?
• Decreased sperm count (oligozoospermia)
• Decreased sperm function

22. Semen Quality
The result regarding semen quality are
inconsistent in obese men
With some studies reporting a significant
association between overweight and low
semen quality and
Other studies reporting no association
Jensen TK, andersson A.M jorgensen N, anderdsen A-G
carlsen E, petersen JH et al. body mass index in relation to
semen quality and reproductive hormones among 1,558 danish men.
Fertil steril , 2004;

23. Idiopathic teratozoo spermia- unexplained
low concentration of
normal looking sperms
What are the changes in the semen
Indices of obese men?

24. • Idiopathic cryptozoospermia - absence of
sperm in routine semen analysis how ever
after centrifugation few sperms are seen.
What are the changes in the semen
Indices of obese men?

25. Sperm DNA Damage
• Studies on semen from Indian men &
Indian obese men have suggested that
spermatozoa from infertile men possess
more DNA damage those from fertile men
• However the correlation with outcome in
ART cycles (IUI & IVF) is not well
established
Venktesh et. al. Andrologia 2009; 41: 251-6

26. All Possible factors
Contributing Infertility
• Decrease Sexual Activity
• Increase Eractile function
• Familial / Genetic factor (possible)
• Peripheral androgen aromatlzation is
often increased in obese men thus
altering HPG axis - & affects fertility
potential

27. Obesity and Infertility
spectrum of abnormalities

28. What are The Mechanism ?
There are three main
mechanisms involved:
1. Oxidative stress
2. Hormonal Imbalance
and hypogonadism
3. Accumulation of
infertility disruptors
4. Family Influence

29. Other Possible mechanism
80% if both parents obese
10% if both parents are
normal weight
Hypothy. Cushing synd.
GH defi. Eating disorders, night
eating syndrome

30. Possible Mechanism of
Infertility in Male Obesity
The Complex mechanism of obesity linking fat
excess to metabolic syndrome are not well
understood.
Studies have suggested that the adverse
effect of male obesity on semen parameters
is mediated by serum leptin , altering
intracellular metabolism and peripheral
tissue receptors in leydig and germ cells
Hofny ERM et. al. fertil steril.2010;94:581-4
Soyupek S. Arch Androl 2005:51;239-46

31. Leptin, adiponectin and resistin
involved in glucose metabolism, Sexual maturation and reproduction;
Excess leptin decreases leydig cell function ( ITT)
And has a direct negative effect on sperm
IL-6, IL -10 TNF a
Increase No production and Oxidative stress
Winters et al. Androl 2006; Jope et al.int J Androl 2003; Hofny et al. fertil sterile 2009;,
Blalas et al. Am J Reprod immunol 2009; Fraczek &
Kurpisc J androl 2007; Lamplao & du plessis reprod blomed online 2008
Possible Mechanism of
Infertility in Male Obesity

32. Obesity, Metabolic Syndrome & Male
Male Infertility
Leptin inhibits testicular
steroidogenesis, decreasing
testosterone synthesis in leydig cell
and inhibiting sperm maturation, as
well as suppressing sertoli cell
function
Margetic S et al. int J obes Relat metab Disord 2002;26:1407-33

33. Treatment Modalities
Life – Style &
Nutrition
Changes
• Diet
• Exercise
• Psychological
Counseling
Surgical
Intervention
• Bariatric
surgery
ART
• IUI
• IVF
• ICSI
Pharmacological intervention
Appetite suppressant, Weight Loss Drugs (Orlistat)
Drugs Increase suicidal tendency

34. Drugs
to decrease weight loss
• Decrease appetite
• Decrease fat absorption
Surgery
• Stomach volume Decrease – full feeling
• Decrease bowel length- decrease absorption of
nutrients

35. Word of caution
Prior to ART therapy
• Dietary weight loss, Regular physical
exercise , elimination of tabacco or alcohol
consumption, behavior modification and
stress management may be of benefit
• Weight loss should be the firstline
treatment. Even 5% - 10% weight loss
should improve fertility outcome.
ESHRE human reproduction 2010;25:578-83

36. Does Weight Loss Improve
Semen Quality
YES
Changes based on % weight loss
Total sperm count (million)
Sperm DNA fregmentation (%)
TT (ng/dL)
Hakonsen LB et al. Reprod Health, 2011

37. Does Medication Improve semen Quality ?

38. Aromates Inhibitors for
Obesity – Related Male Infertility
Yes
It works

39. Aromatase inhibitors for
Obesity – Related Male Infertility

40. Male Hypogonadism
Recombinant hcg; 250 mcg per week; 12 weeks

41. Bariatric Surgery
A serious approach to serious problem
LAP Adjustable Gastric Banding
Given - up procedure in India
SLEEVE Gastrectomy &
Gastric Bypass surgery
are the only alternative &
done routinely
Safety of surgery in India –
in good hands as safe as Lap. Cholecystectomy

42. Bariatric Surgery
A serious approach to serious problem
Literature is scanty
but does suggest that
sperm quality of
infertile men improves
in 6 months to 1 year.

43. Obesity in Men & ART Techniques
• Few studies have shown decrease
likelihood of pregnancy in IVF cycles
• ICSI cycles promise good results

44. 4 cases (operated for Bariatric sugary)
Severe oligospermia 4/4
Failure to ejaculate 2/4
& failure to give specimen
EXPERIENCE

45. EXPERIENCE
• ICSI 2
• TESE – ICSI 2
• Gave success in 2/4 cases
Just like normal weight men

46. Take Home Messages
• Prevalence of obesity has doubled since 1970 s & so
is the infertility in obese men.
• Obesity decreases semen count & quality.
• In obese men - it cause metabolic co-morbidities like
DM, Hypertension , increased cholesterol,
hightriglocyte & raise mortality & morbidity
significantly.
• Wt loss is the key - - but very difficult
• Medical treatment has a promise – needs further
evaluation.
• Pregnancy rate in obese men is highly subnormal in
IVF cycles
• However good result seen in ICSI cycles

47. “Overweight and obese men
are more prone
to infertility”
• Article by Dr Abhishek S Parihar in
Economic times (28.5.14)
• http://economictimes.indiatimes.com/industry/h
Dr Abhishek S Parihar
Director Lifecare IVF

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CONTACT US
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49. Thank You