Category: Reproductive Endocrinology
Objective : Obesity is one of the leading cause of metabolic diseases, and widespread at least more than one-third of adults in the United States are affected. Infertility in men has also been observed in obese patients. Many studies report declines in semen quality, changes in sperm proteomes and erectile dysfunction caused by metabolic syndrome. Many observational studies also have found an association between bariatric surgery and semen quality. Though, the conclusion has not been well-acknowledged. We conducted a systematic review and meta-analysis to comprehensively determine the strength of association between bariatric surgery and semen analysis of the patient before and after the procedure.
Aim: To explore whether there is an improvement in semen quality (including semen quality including concentration, morphology, motility, and volume) in obese patients after bariatric surgery. Setting: Meta-analysis of published studies
We as authors comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). The inclusion criteria were published studies evaluating the effects of bariatric surgery in obese patients. The outcome of interest was semen quality including concentration, morphology, motility, and volume. A meta-analysis comparing the pre- and post-surgery semen quality as mentioned above was performed.
Results: From 102 full-text articles, four observational studies met our inclusion criteria and were included in the meta-analysis based on the random-effects model. There was a significant improvement in motility and volume of semen after bariatric surgery with a standardized mean difference of 7.18 L (95% CI: 3.15-11.12) and 0.65 L (95% CI: 0.03-1.27), respectively. There was no significant change in concentration and morphology after bariatric surgery.
Our systematic review and meta-analysis are the first study that attempted to find an association between bariatric surgery and improvement of semen quality in males in the international literature. The role of bariatric surgery has been proved to help with normalizing the hormone levels, decreased temperature from improving mass-effect, and better lifestyle after surgery which all are likely lead to an improvement of spermatogenesis and sexual function. Based on our result, we suggest that bariatric surgery might have a positive effect for improvement of semen quality including morphology, motility, and volume.
Conclusion : Improvement in semen quality in obese patients was observed after bariatric surgery. Further studies should evaluate risks and benefits of bariatric surgery in obese patients in the aspect of improving fertility outcomes in males.
Sikarin Upala– Felllow, Section of Endocrinology, Diabetes, & Metabolism, Dept. of Medicine, University of Chicago
Subhanudh Thavaraputta– Resident, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
Anawin Sanguankeo– Fellow, Division of Nephrology, Johns Hopkins University School of Medicine
Section of Endocrinology, Diabetes, & Metabolism, Dept. of Medicine, University of Chicago
The second-year clinical fellow at Section of Endocrinology, Diabetes, & Metabolism, Dept. of Medicine, University of Chicago.
Department of Internal Medicine, Texas Tech University Health Sciences Center
The second-year Internal Medicine resident at Texas Tech University Health Sciences Center.