Massive Weight Loss Obtained by Bariatric Surgery Affects Semen Quality in Morbid Male Obesity: a Preliminary Prospective Double-Armed Study

Effect of Bariatric Surgery on Semen Parameters: A Systematic Review and Meta-Analysis

Background

The present systematic review and meta-analysis was performed to explore the possible effect of bariatric surgery on semen parameters.

Material/Methods

Studies on the effect of bariatric surgeries on semen parameters were collected by searching Cochrane Library, PUBMED, EMBASE, MEDLINE, and CNKI databases. We extracted information on essential data and outcome measures, including study design, bariatric surgery, and semen parameters at baseline and after the surgery from the included studies, and STATA 12.0 software was applied to conduct the meta-analysis. Predefined subgroup analyses were also conducted by study design and bariatric surgical procedures. The standard mean difference (SMD) was calculated to estimate the effect on semen parameters.

Results

After the literature search, 6 articles that fulfilled the inclusion criteria were included in the present meta-analysis. The results revealed that patients who had undergone gastric bypass surgery had an increase in semen volume (SMD (95%CI)=0.583 (0.121–1.045), p=0.013). However, the seminal concentration (overall, SMD (95%CI)=−0.123 (−0.418–0.173), p=0.416) and the semen progressive motility (overall SMD (95%CI)=0.148 (−0.148–0.444), p=0.328) remained unchanged after the bariatric surgery. Nevertheless, semen normal morphology experienced an increase in the subgroup of prospective design and sleeve gastrectomy (prospective study, SMD (95%CI)= 0.385 (0.074–0.697), p=0.015, sleeve gastrectomy, SMD (95%CI)=0.880 (0.465–1.296), p=0.000; overall, SMD (95%CI)=0.372 (0.068–0.677), p=0.017).

Conclusions

In conclusion, based on the limitations of the present meta-analysis, definite conclusions cannot be reached regarding the possible effect of bariatric surgery on semen parameters.

Linking sleep disturbance to idiopathic male infertility

Recently published data suggests that male fertility has declined over the past four decades. The reasons for the decline are unclear with up to 50% of cases of male infertility remaining unexplained (idiopathic male infertility). Whilst environmental factors and rising rates of obesity have been implicated, there is now growing evidence that sleep disturbance may be an independent causative factor. Indeed, the prevalence of sleep disturbance appears to be increasing in parallel with deterioration in population sperm quality, a commonly used surrogate marker of male fertility. Although there is some understanding of the relationship between sleep, gonadal hormone secretion and sexual function, it remains to be seen whether sleep disturbance is implicated in idiopathic male infertility. This review will detail the current evidence supporting a link between sleep disturbance and male infertility. Potential mechanistic pathways will be proposed and evidence supporting these pathways will be discussed. Further research is needed in clarifying links between sleep disturbance and idiopathic male infertility. At present the only available treatment option for men with idiopathic infertility is assisted reproductive technology. Demonstration of a causative link between sleep disturbance and idiopathic male infertility may in the future lead to additional treatment options in selected cases.

Frontiers in hormone therapy for male infertility

For a significant number of couples worldwide, infertility is a harsh reality. As specialists in male infertility, much of our armamentarium lacks definitive, evidence-based therapies. For years, we have relied on manipulation of the male hormonal axis to treat those men who help carry the burden of infertility in their partnerships. Indeed, male factor infertility is the sole component of infertility in at least 20% of couples. Further compounding this dilemma is that 25% to 50% of males with infertility have no identifiable etiology and thus present a true management conundrum. This manuscript is an attempt to clarify what therapies exist for the treatment of male factor infertility. We have reviewed the relevant infertility literature honing, our focus on hormonal anomalies and their subsequent impact on fertility. Many of the therapies discussed have been utilized in practice for generations. Thus, this article attempts to provide the evidence-based literature to support the continued use of the current treatment paradigm. Furthermore, we recognize that any review beckons a discussion of what challenges and therapies await on the horizon. For instance, there has been significant interest in restoring spermatogenesis after testosterone replacement therapy (TRT). We explore the adverse long-term spermatogenic outcomes associated with TRT, which with the widespread use of TRT, will inevitably present a great challenge for male infertility specialists. Moreover, we discuss the role of varicocelectomy in the treatment of hypogonadism and infertility, review the association between growth hormone (GH) and male fertility and address the challenges presented by the rising prevalence of obesity.

Review of post bariatric surgery effects on common genitourinary physiology

Background: Obesity is a worldwide challenging health problem. Weight loss through medical management of obesity has not always been successful, thus, giving rise to the need for surgical intervention. Bariatric surgery has been shown to be helpful for morbidly obese patients. However, studies have also shown the effect of surgery on stone formation, fertility and erectile function. This review summarizes the main findings of several studies that analyze stone formation and fertility in men as well as erectile function post bariatric surgery. The underlying pathophysiologic alterations post bariatric surgery include increased absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation. Contradicting data exist on the effect of bariatric surgery on fertility and erectile function. Further studies are needed to analyze the mechanisms.