Table of Contents  
Year : 2014  |  Volume : 16  |  Issue : 5  |  Page : 749-754

The impact of male overweight on semen quality and outcome of assisted reproduction

1 The Fertility Clinic, Viborg Hospital, Skive, Denmark
2 The Fertility Clinic, Viborg Hospital, Skive; Aarhus University, Faculty of Health, Aarhus N, Denmark
3 The Fertility Clinic, Herlev Hospital, Herlev, Denmark
4 Reproductive Medicine Centre, Skanes University Hospital, Malmö, Sweden

Date of Submission12-Sep-2013
Date of Decision05-Nov-2013
Date of Acceptance09-Dec-2013
Date of Web Publication04-Apr-2014

Correspondence Address:
Lise Thomsen
The Fertility Clinic, Viborg Hospital, Skive
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1008-682X.125398

Rights and Permissions

It is well-documented that male overweight and obesity causes endocrine disorders that might diminish the male reproductive capacity; however, reports have been conflicting regarding the influence of male body mass index (BMI) on semen quality and the outcome of assisted reproductive technology (ART). The aim of this study was to investigate whether increased male BMI affects sperm quality and the outcome of assisted reproduction in couples with an overweight or obese man and a non-obese partner. Data was prospectively collected from 612 infertile couples undergoing ART at a Danish fertility center. Self-reported information on paternal height and weight were recorded and BMI was calculated. The men were divided into four BMI categories: underweight BMI < 20 kg m−2 , normal BMI 20-24.9 kg m−2 , overweight BMI 25-29.9 kg m−2 and obese BMI > 30 kg m−2 . Conventional semen analysis was performed according to the World Health Organization guideline and sperm DNA integrity was analyzed by the Sperm Chromatin Structure Assay (SCSA). No statistically significant effect of male BMI was seen on conventional semen parameters (sperm concentration, total sperm count, seminal volume and motility) or on SCSA-results. Furthermore, the outcome of ART regarding fertilization rate, number of good quality embryos (GQE ), implantation and pregnancy outcome was not influenced by the increasing male BMI.

Keywords: assisted reproductive technology; body mass index; male obesity; sperm chromatin structure assay; sperm quality

How to cite this article:
Thomsen L, Humaidan P, Bungum L, Bungum M. The impact of male overweight on semen quality and outcome of assisted reproduction. Asian J Androl 2014;16:749-54

How to cite this URL:
Thomsen L, Humaidan P, Bungum L, Bungum M. The impact of male overweight on semen quality and outcome of assisted reproduction. Asian J Androl [serial online] 2014 [cited 2022 Jan 17];16:749-54. Available from: - DOI: 10.4103/1008-682X.125398

  Introduction Top

The average body mass index (BMI) in Denmark for both men and women is rising in accordance with the trend seen in other Western countries. [1],[2],[3] In 2003, 26% of 18-year-old Danish conscripts were overweight (BMI > 25 kg m−2 ), of whom 25% were obese (BMI > 30 kg m−2 ). [4] During the last decade this figure has increased by 20%, thus, at present every third Danish 18-year-old man is overweight. [4] In parallel with the global increase in obesity, a possible decrease in sperm count and fecundity was reported. [5],[6]

It is well-known that female weight disturbances has impact on the fertility potential and that obesity affects fertility negatively in terms of hormonal disturbances, [7],[8] increased risk of polycystic ovary syndrome, [7] anovulation [8] as well as poorer results after assisted reproductive technology (ART). [3],[9],[10] As a consequence, many European fertility clinics require female weight loss to a specific BMI threshold before initiating ART treatment. [11]

From the male perspective, however, it is still unclear to what extent overweight and obesity affects sperm quality and the chances of conceiving-spontaneously as well as after ART. The relatively limited data published are conflicting, [12],[13],[14],[15] and therefore, it is still uncertain whether male weight loss will increase natural or assisted fertility. However, it has been shown that obesity may affect male fertility in several ways: either through an increased risk of erectile dysfunction, [9],[16] increased temperature of the testes, [17] hormonal disturbances, [18],[19],[20] impaired sperm quality [21],[22] or impaired sperm DNA integrity. [23],[24],[25] Two recently published meta-analyses [19],[20] reported no clear correlation between increasing male BMI and the conventional sperm parameters. However, there could be other factors in the overweight male which diminish the reproductive capacity, for example, an increased sperm DNA fragmentation rate [23],[24] or a reduced oocyte-sperm binding capacity. [26] These changes, if present, will not be reflected in the conventional semen analysis, but could affect the outcome of ART.

In clinical life we are often presented with overweight male patients and there is a need for more studies to clarify whether male overweight represents a problem for the outcome of ART as this topic until now has only been discussed in a few studies. [12],[13],[14],[27]

Therefore, the primary aim of this study was to investigate whether increased male BMI affects the outcome of ART in terms of fertilization rate, number of good quality embryos (GQE), implantation rate (IR), clinical pregnancy rate and delivery rate. A second aim was to explore whether increased BMI has any impact on sperm DNA integrity as measured by Sperm Chromatin Structure Assay (SCSA) as well as the conventional semen parameters (sperm concentration, toal sperm count, semen volume and sperm motility) in men undergoing ART. Thirdly, we wanted to examine whether the mode of fertilization has any impact on the outcome of ART in different BMI categories.

  Materials and Methods Top

Patients and study design

The study was based on a cohort of 1250 infertile couples undergoing ART at The Fertility Clinic, Skive, Viborg Hospital, Denmark during the period April 2002 to December 2003. Couples were included consecutively in the study. Data regarding the predictive value of SCSA have already been reported, [28],[29],[30] however, in these publications data were not analyzed in relation to male BMI. In 612 of the 1250 cycles, self-reported information about paternal height and weight were available and BMI could thus be calculated. The population included 167 intrauterine inseminations (IUIs), 233 in vitro fertilization (IVF) cycles, 126 intracytoplasmic sperm injection (ICSI) cycles and 86 split cycles (50%IVF/50%ICSI). Maternal height and weight were measured by trained staff. For each individual, the BMI was calculated as kg m−2 . Male patients were initially grouped according to BMI as follows: underweight < 20 kg m−2 , normal weight 20-24.9 kg m−2 , overweight 25-29.9 kg m−2 and obese > 30 kg m−2 . These BMI categories were used in previous studies with similar aims as the present study. [12],[23] When analyzing data regarding pregnancy and delivery, the underweight (<20 kg m−2 ) group was omitted, due to its small sample size (n = 11).

Using the World Health Organization class I, II and III on the obese group, the 74 males were distributed as follows: class I: 64, class II: 6 and class III: 4. Due to the limited number of patients in groups II and III, all statistical analysis on the obese male patients were made on the total obese group (n = 74).

Data in this study was collected as part of a larger study designed to investigate the predictive role of sperm DNA fragmentation in assisted reproduction. In order to minimize a potential influence of female infertility problems, women with BMI > 30 kg m−2 and follicle stimulating hormone >10 IU were excluded.

In order to obtain sufficient numbers of sperm for SCSA analysis, only men having a sperm concentration of at least one million per ml in neat semen were included in the study.

All female partners were self-reported nonsmokers. Male smoking habits are given in [Table 1].
Table 1: Demographic data according to male BMI, total study population

Click here to view

Prior to the ART treatment all male participants were asked to complete a questionnaire to report the length of sexual abstinence prior to providing the semen sample. Moreover, information on medical and reproductive history and lifestyle factors, including alcohol consumption and smoking status was recorded.

The primary study on the role of sperm DNA fragmentation for the outcome of ART was approved by the Ethics Committee of Viborg County (No. VN2002/25). An Institutional Review Board approval was not required for the present study due to its retrospective nature and the fact that the study data completely excluded the identification of subjects. All patients had given written authorization at the time of treatment for the future use of their clinical data.

ART procedures

In IUI-patients, all hormone stimulation and insemination procedures were performed as previously described. [28] In IVF/ICSI patients hormonal treatment, ovum pick up, gamete handling and culture and embryo transfer (ET) were performed as previously described. [28],[29] A maximum of two embryos were transferred on day 2 or 3 following ovum pick up.

Conventional semen analysis

Semen was collected onsite by masturbation in sterile containers on the day of ovum pick up or IUI. A period of 3-5 days of sexual abstinence prior to the sample collection was recommended. Semen analysis was performed within 1 h after ejaculation. One hundred microliters of the raw semen sample was frozen at -80 °C for later SCSA analysis. Semen analysis was performed according to the World Health Organization guidelines [31] in regard to semen volume, sperm concentration, total sperm count and sperm motility. Sperm morphology was not assessed.

Sperm chromatin structure assay

Sperm DNA integrity was analyzed by the SCSA at the Reproductive Medicine Centre, Skanes University Hospital, Malmφ, Sweden. Details of this analysis have previously been described elsewhere. [28]

In brief, SCSA is a flow cytometric technique which identifies spermatozoa with abnormal chromatin packaging defined as susceptibility to acid-induced DNA denaturation in situ. [32],[33] The analysis is based on the fact that damaged sperm chromatin denatures when exposed to an acid-detergent, whereas normal double-stranded chromatin remains stable and intact. After a low pH challenge acridine orange staining is used to distinguish between denaturated single stranded DNA and native double stranded DNA regions as acridine orange under these experimental conditions emits red fluorescence when intercalated with single-stranded damaged DNA and green fluorescence when associated with stable native double stranded DNA. The level of DNA breaks is expressed by the DNA fragmentation index (DFI) which is the ratio of red to total (red plus green) fluorescence intensities in the flow cytometric analysis, i.e. the level of denatured DNA over the total DNA. In addition to DFI the SCSA-parameter high DNA stainability (HDS) was also assessed. HDS was calculated as the percentage of sperm with high levels of green fluorescence, which are thought to represent immature spermatozoa with incomplete chromatin condensation. [33]

Cells were analyzed using a FACScan flow cytometer (Becton Dickinson, San Jose, CA, USA), equipped with an air-cooled argon ion laser. A total of 10 000 events were accumulated for each measurement at a flow rate 200-300 cells per second. A reference sample was run for every fifth sample. The intralaboratory coefficient of variation was found to be 4.5% for DFI and 10% for HDS, respectively.

Reproductive outcome parameters

Normal fertilization was defined as two visible pronuclei (PN) 16-18 h after ICSI or IVF insemination. Fertilization rate was calculated as numbers of 2PN per metaphase II oocytes available. GQE represents the number of embryos for ET plus the number of embryos cryopreserved.

A positive pregnancy was determined as a serum beta-human chorionic gonadotropin (hCG) level > 10 IU on day 12 after ET. IR was calculated as the ratio of gestational sacs determined by ultrasound after 7 weeks in relation to the total number of embryos transferred (a maximum of two).

A clinical pregnancy was determined as the presence of a fetal heartbeat on ultrasound examination 4-6 weeks after ET (pregnancy week 7 or 8).

Statistical analysis

For the analysis of potential associations between BMI and sperm quality in terms of sperm concentration, total sperm count, motility, volume, DFI and HDS the total study group regardless of ART treatment type (IUI, IVF, ICSI and split) was included.

In the analysis of reproductive outcome for in vitro fertilization only IVF and ICSI cycles were included. Split cycles were excluded as some of these patients had a mix of IVF and ICSI embryos transferred.

The reproductive outcome regarding IUI is presented separately.

As the distribution of semen parameters was skewed, we calculated the median and range in each BMI category. Where appropriate, for background data and reproductive outcome parameters mean and standard deviation (s.d.) was calculated.

Mean values for all parameters except reproductive outcome were tested in a linear regression analysis model with the respective parameters as dependent factors and the four BMI categories as independent factors. For the reproductive outcome parameters (implantation, positive hCG, clinical pregnancy rate and deliveries); however, odds ratios (OR) with 95% confidence intervals (CI) were estimated for the three highest BMI categories, using binary logistic regression analysis. The normal weighted men (20-24.9 kg m−2 ) were used as reference for this analysis. After inclusion of male smoking habits, female age, female BMI and number of previous ART-treatments in the statistical model, the ORs for reproductive outcome were unchanged.

The underweight group (<20 kg m−2 ) was omitted from this part of the statistical analysis, due to its small sample size.

Statistical analysis was performed using statistical software (Statistical Package for Social Sciences 17.0 for Windows; SPSS Inc, Chicago, IL, USA). P < 0.05 was considered statistically significant.

  Results Top

Demographic data

The mean (s.d.) age of the men in the total study population of 612 ART cycles was 32.8 (5.1) years and the corresponding age for the women was 31.6 (4.4) years. For both men and women, no statistical difference in age was seen between the four BMI categories [Table 1].

The mean BMI of the total study population was 25.9 (3.5). Of 612 male patients 1.8% (n = 11) were underweight, 42.3% (n = 259) were of normal weight, 43.8% (n = 268) were overweight and 12.1% (n = 74) were obese. Of the obese male patients 64 were Class I (BMI 30-34.9 kg m−2 ), six were Class II (BMI 35-39.9 kg m−2 ) and four were Class 3 (BMI > 40 kg m−2 ). There was no statistically significant difference in the cause of infertility (anovulation/tubal disease/endometriosis/male factor/unexplained) between the groups (data not shown); nor in the number of previous ART treatments performed, female follicle stimulating hormone and female BMI [Table 1]. Neither alcohol consumption nor smoking habits differed between the male BMI categories. The incidence of diabetes mellitus, recent infections or use of medicine with potential negative effect on sperm quality did not differ between male BMI categories (data not shown).

When sorting data according to mode of fertilization (IVF or ICSI), an identical analysis was performed. Women from the IVF group with overweight partners (BMI 25-29.9 kg m−2 ) had a slightly higher number of oocytes retrieved compared to those with an obese partner with a BMI > 30 kg m−2 , a mean (s.d.) of 9.0 (4.7) vs 7.1 (7.0) oocytes (P = 0.04) [Table 2]. After adjusting for female BMI the P values remained unchanged.
Table 2: Fertilisation, number of good quality embryos and implantation in IVF and ICSI groups according to male BMI

Click here to view

Sperm quality

No significant effect of male BMI was seen on sperm concentration, total sperm count, semen volume or motility. Levels of DFI and HDS as measured with SCSA did not differ significantly across the BMI groups [Table 3].
Table 3: Conventional semen analysis and SCSA-results according to male BMI, total study population

Click here to view

Reproductive outcome


In IVF and ICSI patients neither rates of positive hCG, clinical pregnancy and deliveries differed significantly between BMI categories [Table 4]. Setting the normal BMI group (BMI 20-24.9 kg m−2 ) as a reference, for IVF patients the ORs and 95% CI for positive hCG for the overweight and obese groups were 0.6 (0.3-1.5) and 0.5 (0.1-1.8), respectively. The corresponding values for positive hCG in the ICSI group were 1.2 (0.6-2.2) and 1.0 (0.4-2.3). Regarding delivery the ORs and 95% CI for the overweight IVF group were 1.1 (0.6-2.1) and 0.8 (0.3-2.6) in the obese group. For ISCI patients ORs for delivery were 0.5 (0.2-1.1) in the overweight group and 0.4 (0.1-1.6) in the obese group [Table 4].
Table 4: Reproductive outcome of IVF and ICSI according to male BMI

Click here to view

No statistically significant differences were seen in fertilization rate, number of GQE or IR between the three BMI groups-neither when data was treated as one group (IVF + ICSI) nor when treated separately (IVF vs ICSI) [Table 2]. As previously reported, [29] fertilization and embryo development were not related to DFI or HDS levels.


A comparison of the three BMI groups revealed no statistically significant differences regarding positive hCG, clinical pregnancy rate or deliveries. Setting the normal BMI group as reference, the OR and 95% CI for both positive hCG and clinical pregnancy were 0.8 (0.4-2.0) for BMI group 25.0-29.9 kg m−2 and 0.8 (0.2-3.2) for the group with BMI > 30 kg m−2 [Table 5]. Odds ratio for delivery in the overweight group (BMI 25.0-29.9 kg m−2 ) was 0.9 (0.3-2.6) and 1.7 (0.4-7.0) for the obese group (BMI > 30 kg m−2 ).
Table 5: Reproductive outcome of intrauterine insemination according to male BMI

Click here to view

  Discussion Top

The present study indicates that male overweight and obesity does not seem to have any negative impact on the outcome of ART (IUI, IVF and ICSI) in males patients in the reproductive age partnered with non-obese females. Moreover, the present data show that in men undergoing ART, sperm quality in terms of sperm DNA integrity and conventional sperm parameters are not negatively affected by a higher male BMI.

During the last decade several reports on the effects of increased male BMI on fertility have been published. [19],[21],[12],[13],[15] It is well-documented that male overweight causes endocrine disorders in terms of decreased sex hormone binding globulin and decreased total testosterone levels. [19] As spermatogenesis is driven mainly by the action of free testosterone and follicle stimulating hormone which seem to be only slightly influenced by male overweight and obesity; [19],[20] it seems biologically plausible that semen parameters are not affected in this group of patients in spite of an altered endocrine profile.

While some studies reported that male overweight leads to a decreased sperm count, [12],[15],[21],[34],[35] others did not find this association. [18],[19],[36],[37] Most studies reported that neither sperm motility [18],[21],[24],[38],[39] nor morphology [12],[21],[24],[38] and semen volume [21],[34],[36],[38],[39] were impaired as a result of increased male BMI.

Due to the poor predictive role of conventional sperm parameters, [40],[41] an increasing focus on the role of sperm DNA integrity in fertility has been noted. [42] While the negative role of a high DFI as measured by SCSA is very clear in in vivo fertility, natural conception [43],[44],[45] and IUI; [28],[29] the role of a high DFI in IVF and ICSI is more unclear. The risk of having a high number of DNA damaged sperm has been linked to several causes and mechanisms, [42] among others increased BMI. [23],[24] Recently, Dupont et al.,[46] Chavarro et al.[24] and Kort et al.[23] reported an increased sperm DNA fragmentation rate in overweight [23] and obese [23],[24],[46] men compared to normal weight men; however, these findings have been contrasted by others. [15],[47],[48]

So far, only a few previous reports have studied the effects of an increased BMI on the outcome of ART. [12],[13],[14],[27],[35] Thus, Bakos and colleagues [12] found no relationship between paternal BMI and early embryo development in a retrospective study including 305 men undergoing IVF or ICSI; however, a reduced blastocyst development, impaired IR, reduced clinical pregnancy rate and live birth rate were observed with increasing male BMI. The authors hypothesized that the decrease in blastocyst development might be caused by increased DNA damage in the overweight and obese group as demonstrated by Kort et al.[23] and Charvarro et al.[24]

Recently, Keltz and colleagues [13] also reported the clinical pregnancy rate to be declining with increasing male BMI, reporting a 79% reduction in the chance of conceiving if IVF rather than ICSI was chosen in obese men; thus, underlining a possible negative influence on oocyte-spermatozoa interaction. This was contrasted by Kupka et al.[14] who retrospectively analyzed data covering 12 years from the national German IVF Registry, including 650 452 cycles from 120 centers. In their large retrospective analysis, the highest clinical pregnancy rates for both IVF and ICSI were seen in a normal-weight female with an obese male partner (P = 0.0028). A recent Danish study by Petersen et al.[27] analyzed 25.191 IVF/ICSI cycles from the IVF registry and showed that IVF-treated couples with both partners having BMI > 25 kg m−2 had the lowest odds of live birth compared with couples with both partners having BMI < 25 kg m−2 . They found higher odds of live birth after ICSI treatment compared with IVF among overweight and obese men supporting the hypothesis that ICSI may overcome a possible obesity-related impairment of the sperm-egg interaction. [27]

On the other hand, another recent study by Braga et al.[35] found no effect of male overweight on the fertilization rate, IR and pregnancy rate after ICSI. However, as none of the studies mentioned were randomized controlled trials several potential confounders and selection biases might have influenced the findings.

Taken together, in most of the studies performed until now the number of men with BMI > 35 kg m−2 has been low which might disguise the possible true negative effect of morbid obesity on male reproductive potential. Although a good epidemiological study is often better than a small prospective trial, the study by Håkonsen and colleagues [15] calls for attention, showing a significant impact of weight loss on sperm quality in morbidly obese men. As this study included 43 patients, only, there is clearly a need for a larger follow-up study.

The present study was based on the hypothesis that sperm quality could be impaired in overweight and obese men, which might affect the results of ART; however, no effect of a high BMI was seen on the results of IUI, IVF and ICSI. Our findings obviously contrast those of Bakos et al.[12] who reported a linear correlation between increasing male BMI and the ART outcome, when assessing blastocyst development, IR, pregnancy rate, clinical pregnancy rate and live birth rate. The mode of fertilization (IVF or ICSI) could potentially play a role for the outcome parameters, in particular if our hypothesis of an increased DFI in the obese men was correct. Previously we published evidence for a threefold better clinical pregnancy rate if ICSI was chosen prior to IVF in couples where the male partner had a DFI above 30%. [29]

In concordance with the findings of Håkonsen and co-workers, [15] the present study found DFI to be similar in all BMI groups. Thus, a potential decreased sperm-egg interaction in overweight male patients seems not to be caused by increased DNA damage in spermatozoa. While Håkonsen et al. [15] included 43 obese men, only, with a BMI > 33, our study was based on as many as 612 men with BMI of wider ranges.

A recent study by Sermondade et al.[49] evaluated for the first time in humans the association between male BMI and sperm-zona pellucida binding ability by the zona binding test and found no statistically significant effect of BMI on the ability of sperm to bind to the zona pellucida.

Limitations of the present study are the reduced number of patients with severe obesity (World Health Organization Class II and III) and the fact that male BMI were only available as self-reported data which in general tends to overestimate height and underestimate weight [50] although this seems to be more modest in male patients. [51] A recent Danish study concerning body size and time-to-pregnancy showed an excellent agreement between self-reported BMI and measures provided by the Danish Medical Birth Registry on the same women indicating that Danish participants respond honestly when asked about weight and height. [52]

From a clinical point of view, data is still scarce concerning the question whether male weight loss prior to ART is likely to improve sperm quality and the reproductive outcome and can only be answered through well-designed prospective randomized controlled intervention studies. At present, only two smaller studies with this design have been published [15],[53] due to the limited sample size of these study populations; however, no firm conclusions could be reached.

In conclusion, the results of the present study indicate that in men with a non-obese partner a high male BMI does not have a negative impact on neither the ART outcome nor the semen quality. However, in order to draw firm conclusions, relevant for daily clinical practice, the findings should be replicated in a larger ART-cohort including a wider range of BMI levels.

  Author Contributions Top

LT, PH, LB and MB have all given substantial contributions to conception and design of the present study. All authors have contributed to acquisition of data, analysis as well as interpretation of data. MB has conducted the statistical analysis. LT has drafted the manuscript and PH, LB and MB have revised the content critically. All co-authors approved the final draft prior to submission.

  Competing Interests Top

All authors declare no competing interests.

  References Top

1.Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006; 295: 1549-55.  Back to cited text no. 1
2.Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States, 2005-2008. NCHS Data Brief 2010: 1-8.  Back to cited text no. 2
3.Maheshwari A, Stofberg L, Bhattacharya S. Effect of overweight and obesity on assisted reproductive technology--a systematic review. Hum Reprod Update 2007; 13: 433-44.  Back to cited text no. 3
4.Statistics Denmark. Kvinder og Mænd 2011: 30-31. Available from: [Last accessed on].  Back to cited text no. 4
5.Carlsen E, Givercman A, Keiding N, Skakkebæk NE. Evidence of decreasing quality of semen during past 50 years. BMJ 1992; 305: 609-13.  Back to cited text no. 5
6.Swan SH, Elkin EP, Fenster L. The question of declining sperm density revisited: an analysis of 101 studies published 1934-1996. Environ Health Perspect 2000; 108: 961-6.  Back to cited text no. 6
7.Pasquali R, Pelusi C, Genghini S, Cacciari M, Gambineri A. Obesity and reproductive disorders in women. Hum Reprod Update 2003; 9: 359-72.  Back to cited text no. 7
8.Loret de Mola JR. Obesity and its relationship to infertility in men and women. Obstet Gynecol Clin North Am 2009; 36: 333-46.  Back to cited text no. 8
9.Pasquali R, Patton L, Gambineri A. Obesity and Infertility. Curr Opin Endocrinol Diabetes Obes 2007; 14: 482-7.  Back to cited text no. 9
10.Pinborg A, Gaarslev C, Hougaard CO, Nyboe Andersen A, Andersen PK, et al. Influence of female bodyweight on IVF outcome: a longitudinal multicentre cohort study of 487 infertile couples. Reprod Biomed Online 2011; 23: 490-9.  Back to cited text no. 10
11.Zacheriah M, Fleming R, Acharya U. Management of obese women in assisted conception units: a UK survey. Hum Fertil (Camb) 2006; 9: 101-5.  Back to cited text no. 11
12.Bakos HW, Henshaw RC, Mitchell M, Lane M. Paternal body mass index is associated with decreased blastocyst development and reduced live birth rates following assisted reproductive technology. Fertil Steril 2011; 95: 1700-4.  Back to cited text no. 12
13.Keltz J, Zapantis A, Jindal SK, Lieman HJ, Santoro N, et al. Overweight men: clinical pregnancy after ART is decreased in IVF but not in ICSI cycles. J Assist Reprod Genet 2010; 27: 539-44.  Back to cited text no. 13
14.Kupka MS, Gnoth C, Buehler K, Dahncke W, Kruessel JS. Impact of female and male obesity on IVF/ICSI: results of 700,000 ART-cycles in Germany. Gynecol Endocrinol 2011; 27: 144-9.  Back to cited text no. 14
15.Håkonsen LB, Thulstrup AM, Aggerholm A, Olsen J, Bonde JP, et al. Does weight loss improve semen quality and reproductive hormons? Results from a cohort of severly obese men. Reprod Health 2011; 8: 24.  Back to cited text no. 15
16.Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, et al. A prospective study of risk factors for erectile dysfunction. J Urol 2006; 176: 217-21.  Back to cited text no. 16
17.Hammoud AO, Wilde N, Gibson M, Parks A, Carrell DT, et al. Male obesity and alteration in sperm parameters. Fertil Steril 2008; 90: 2222-5.  Back to cited text no. 17
18.Aggerholm A, Thulstrup AM, Toft G, Ramlau-Hansen C, Bonde JP. Is overweight a risk factor for reduced semen quality and altered serum sex hormone profile? Fertil Steril 2008; 90: 619-26.  Back to cited text no. 18
19.MacDonald AA, Herbison GP, Showell M, Farquhar CM. The impact of body mass index on semen parameters and resproductive hormones in human males: a systematic review with meta-analysis. Hum Reprod Update 2010; 16: 293-311.  Back to cited text no. 19
20.Teerds KJ, de Rooij DG, Keijer J. Functional relationship between obesity and male reproduction: from humans to animal models. Hum Reprod Update 2011; 17: 667-83.  Back to cited text no. 20
21.Jensen TK, Andersson AM, Jørgensen N, Andersen AG, Carlsen E, et al. Body mass index in relation to semen quality and reproductive hormons among 1,558 Danish men. Fertil Steril 2004; 82: 863-70.  Back to cited text no. 21
22.Ramlau-Hansen CH, Thulstrup AM, Norhr EA, Bonde JP, Sørensen TI, et al. Subfecundity in overweight and obese couples. Hum Reprod 2007; 22: 1634-7.  Back to cited text no. 22
23.Kort HI, Massay JB, Elsner CW, Mitchell-Leef D, Shapiro CB, et al. Impact of body mass index values on sperm quantity and quality. J Androl 2006; 27: 450-2.  Back to cited text no. 23
24.Chavarro JE, Toth TL, Wright DL, Meeker JD, Hauser R. Body mass index in relation to semen quality, sperm DNA integrity, and serum reproductive hormon levels among men attending an infertility clinic. Fertil Steril 2010; 93: 2222-31.  Back to cited text no. 24
25.La Vignera S, Condorelli RA, Vicari E, Calogero AE. Negative effect of increased body weight on sperm conventional and nonconventional flow cytometric sperm parameters. J Androl 2012; 33: 53-8.  Back to cited text no. 25
26.Wegner CC, Clifford AL, Jilbert PM, Henry MA, Gentry WL. Abnormally high body mass index and tobacco use are associated with poor sperm quality as revealed by reduced sperm binding to hyaluronan-coated slides. Fertil Steril 2010; 93: 332-4.  Back to cited text no. 26
27.Petersen GL, Schmidt L, Pinborg A, Kamper-Jorgensen M. The influence of female and male body mass index on live births after assisted reproductive technology treatment: a nationwide register-based cohort study. Fertil Steril 2013; 99: 1654-62.  Back to cited text no. 27
28.Bungum M, Humaidan P, Spano M, Jepson K, Bungum L, et al. The predictive value of sperm chromatin structure assay (SCSA) for the outcome of intrauterine insemination, IVF and ICSI. Hum Reprod 2004; 19: 1401-8.  Back to cited text no. 28
29.Bungum M, Humaidan P, Axmon A, Spano M, Bungum L, et al. Sperm DNA integrity assessment in prediction of assisted reproduction technology outcome. Hum Reprod 2007; 22: 174-9.  Back to cited text no. 29
30.Bungum M, Spano M, Humaidan P, Eleuteri P, Rescia M, et al. Sperm chromatin structure assay parameters measured after density gradient centrifugation are not predictive for the outcome of ART. Hum Reprod 2008; 23: 4-10.  Back to cited text no. 30
31.World Health Organization. WHO Laboratory Manual for the Examination of Human Sperm and Sperm-cervical mucus interaction. Cambridge University Press; 1999.  Back to cited text no. 31
32.Evenson D, Darzynkiewicz Z, Melamed MR. Relation of mammalian sperm chromatin heterogeneity to fertility. Science 1980; 210: 1131-3.  Back to cited text no. 32
33.Evenson D, Jost L. Sperm chromatin structure assay is useful for fertility assessment. Methods Cell Sci 2000; 22: 169-89.  Back to cited text no. 33
34.Magnusdottir EV, Thorsteinsson T, Thorsteinsdottir S, Heimisdottir M, Olafsdottir K. Persistent organochlorines, sedentary occupation, obesity and human male subfertility. Hum Reprod 2005; 20: 208-15.  Back to cited text no. 34
35.Braga DP, Halpern G, Figueria Rde C, Setti AS, Iaconelli A Jr, et al. Food intake and social habits in male patients and its relationship to intracytoplasmic sperm injection outcomes. Fertil Steril 2012; 97: 53-9.  Back to cited text no. 35
36.Qin DD, Yuan W, Zhou WJ, Cui YQ, Wu JQ, et al. Do reproductive hormones explain the association between body mass index and semen quality? Asian J Androl 2007; 9: 827-34.  Back to cited text no. 36
37.Li Y, Lin H, Ma M, Li L, Cai M, et al. Semen quality of 1346 healthy men, results from the Chongqing area of southwest China. Hum Reprod 2009; 24: 459-69.  Back to cited text no. 37
38.Fejes I, Koloszar S, Zacaczki Z, Daru J, Szöllösi J, et al. Effect of body weigth on testosterone/estradiol ratio in oligozoospermic patients. Arch Androl 2006; 52: 97-102.  Back to cited text no. 38
39.Pauli EM, Legro RS, Demers LM, Kunselman AR, Dodson WC, et al. Diminished paternity and godadal function with increasing obesity in men. Fertil Steril 2008; 90: 346-50.  Back to cited text no. 39
40.Bonde JP, Ernst E, Jensen TK, Hjollund NH, Kolstad H, et al. Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners. Lancet 1998; 352: 1172-7.  Back to cited text no. 40
41.Guzick DS, Overstreeet JW, Factor-Litvak P, Brazil CK, Nakajima ST, et al., National Cooperative Reproductive Medicine Network. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J 2001; 345: 1388-93.  Back to cited text no. 41
42.Erinpreiss J, Spano M, Erinpreisa J, Bungum M, Giwercman A. Sperm chromatin structure assay and male fertility: biological and clinical aspects. Asian J Androl 2006; 8: 11-29.  Back to cited text no. 42
43.Evenson DP, Larson KL, Jost LK. Sperm chromatin structure assay: its clinical use for detecting sperm DNA fragmentation in male infertility and comparisons with other techniques. J Androl 2002; 23: 25-43.  Back to cited text no. 43
44.Spano M, Bonde JP, Hjøllund HI, Kolstad HA, Cordelli E, et al. Sperm chromatin damage impairs human fertility. The Danish First Pregnancy Planner Study Team. Fertil Steril 2000; 73: 43-50.  Back to cited text no. 44
45.Giwercman A, Lindstedt L, Larsson M, Bungum M, Spano M, et al. Sperm chromatin structure assay as an independent predictor of fertility in vivo: a case-control study. Int J Androl 2010; 33 : e221-7.  Back to cited text no. 45
46.Dupont C, Faure C, Sermondade N, Boubaya M, Eustache F, et al. Obesity leads to higher risk of sperm DNA damage in infertile patients. Asian J Androl 2013; 15: 622-5.  Back to cited text no. 46
47.Rybar R, Kopecka V, Prinosilova P, Markova P, Rubes J. Male obesity and age in relationship to semen parameters and sperm chromatin integrity. Andrologia 2011; 43: 286-91.  Back to cited text no. 47
48.Smit M, Romijn JC, Wildhagen MF, Weber RF, Dohle GR. Sperm chromatin structure is associated wiht the quality of spermatogenesis in infertile patients. Fertil Steril 2010; 94: 1748-52.  Back to cited text no. 48
49.Sermondade N, Dupont C, Faure C, Boubaya M, Cedrin-Durnerin I, et al. Body mass index is not associated with sperm-zona pellucida binding ability in subfertile males. Asian J Androl 2013; 15: 626-9.  Back to cited text no. 49
50.Connor Gorber S, Tremblay M, Moher D, Gorber B. A comparison of direct vs self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev 2007; 8: 307-26.  Back to cited text no. 50
51.Sherry B, Jefferds ME, Grummer-Strawn LM. Accuracy of adolescent self-report of height and weight in assessing overweight status: a literature review. Arch Pediatr Adolesc Med 2007; 161 :1154-61.  Back to cited text no. 51
52.Wise LA, Rothman KJ, Mikkelsen EM, Sorensen HT, Riss A, et al. An internet-based prospective study of body size and time-to-pregnancy. Hum Reprod 2010; 25: 253-64.  Back to cited text no. 52
53.Reis LO, Zani EL, Saade RD, Chaim EA, de Oliveira LC, et al. Bariatric surgery does not interfere with sperm quality--preliminary long-term study. Reprod Sci 2012; 19: 1057-62.  Back to cited text no. 53


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]

This article has been cited by
1 High fat diet-induced obesity prolongs critical stages of the spermatogenic cycle in a Ldlr-/-.Leiden mouse model
D. Komninos, L. Ramos, G. W. van der Heijden, M. C. Morrison, R. Kleemann, A. E. van Herwaarden, A. J. Kiliaan, I. A. C. Arnoldussen
Scientific Reports. 2022; 12(1)
[Pubmed] | [DOI]
2 Assisted reproductive technology outcomes in obese and diabetic men: lighting the darkness
Lis C. Puga Molina,Pedro F. Oliveira,Marco G. Alves,David Martin-Hidalgo
F&S Reviews. 2021;
[Pubmed] | [DOI]
3 Do aging, drinking, and having unhealthy weight have a synergistic impact on semen quality?
Nicolás Ramírez,Gustavo Estofán,Andrea Tissera,Rosa Molina,Eugenia Mercedes Luque,Pedro Javier Torres,Arnaldo Mangeaud,Ana Carolina Martini
Journal of Assisted Reproduction and Genetics. 2021;
[Pubmed] | [DOI]
4 Obesity and reproduction: a committee opinion
Fertility and Sterility. 2021;
[Pubmed] | [DOI]
5 Lifestyle in urology: Benign diseases
Riccardo Bientinesi,Carlo Gandi,Luigi Vaccarella,Emilio Sacco
Urologia Journal. 2021; 88(3): 163
[Pubmed] | [DOI]
6 Effect of Female and Male Body Mass Index on Cumulative Live Birth Rates in the Freeze-all Strategy
Xi Shen, Yating Xie, Di Chen, Wenya Guo, Gang Feng, Weiming Jiang, Hui Long, Qifeng Lyu, Wei Jin, Yanping Kuang, Li Wang
The Journal of Clinical Endocrinology & Metabolism. 2021;
[Pubmed] | [DOI]
7 Obesity and Male Reproduction; Placing the Western Diet in Context
Taylor Pini,David Raubenheimer,Stephen J. Simpson,Angela J. Crean
Frontiers in Endocrinology. 2021; 12
[Pubmed] | [DOI]
8 Potential Adverse Effects of Female and Male Obesity on Fertility: A Narrative Review
Mina Amiri,Fahimeh Ramezani Tehrani
International Journal of Endocrinology and Metabolism. 2020; 18(3)
[Pubmed] | [DOI]
9 Male adiposity, sperm parameters and reproductive hormones: An updated systematic review and collaborative meta-analysis
Albert Salas-Huetos,Leila Maghsoumi-Norouzabad,Emma R. James,Douglas T. Carrell,Kenneth I. Aston,Timothy G. Jenkins,Nerea Becerra-Tomás,Ahmad Zare Javid,Reza Abed,Pedro Javier Torres,Eugenia Mercedes Luque,Nicolás David Ramírez,Ana Carolina Martini,Jordi Salas-Salvadó
Obesity Reviews. 2020;
[Pubmed] | [DOI]
10 Body mass index and age correlate with antioxidant supplementation effects on sperm quality: Post hoc analyses from a double-blind placebo-controlled trial
Gian Maria Busetto,Francesco Del Giudice,Ashraf Virmani,Alessandro Sciarra,Martina Maggi,Matteo Ferro,Angelo Porreca,Benjamin I. Chung,Ashok Agarwal,Ettore De Berardinis
Andrologia. 2020;
[Pubmed] | [DOI]
11 Recommandations de l’AFU et de la SALF concernant l’évaluation de l’homme infertile
Eric Huyghe,Florence Boitrelle,Charlotte Methorst,Roger Mieusset,Pierre F. Ray,William Akakpo,Isabelle Koscinski,Céline Chalas,Nathalie Rives,Ingrid Plotton,Geoffroy Robin,Rabi El Osta,Sylviane Hennebicq,Florence Eustache,François Marcelli,Hervé Lejeune
Progrès en Urologie. 2020;
[Pubmed] | [DOI]
12 Should empiric therapies be used for male factor infertility?
Kai J. Buhling,Peter Chan,Martin Kathrins,Marian Showell,Sarah C. Vij,Mark Sigman
Fertility and Sterility. 2020; 113(6): 1121
[Pubmed] | [DOI]
13 The effect of body mass index on sperm DNA fragmentation: a systematic review and meta-analysis
Mahdi Sepidarkish,Arezoo Maleki-Hajiagha,Saman Maroufizadeh,Mahroo Rezaeinejad,Amir Almasi-Hashiani,Maryam Razavi
International Journal of Obesity. 2020;
[Pubmed] | [DOI]
14 Recategorisation of body mass index to achieve andrological predictive power: a study in more than 20 000 patients
Nicolás Ramírez,Rosa Inés Molina,Andrea Tissera,Eugenia Mercedes Luque,Pedro Javier Torres,Santiago Bianconi,Fernando Beltramone,José Sad-Larcher,Gustavo Estofán,Arnaldo Mangeaud,Ana Carolina Martini
Reproduction, Fertility and Development. 2020; 32(7): 648
[Pubmed] | [DOI]
15 Metabolic diseases affect male reproduction and induce signatures in gametes that may compromise the offspring health
Sara C Pereira,Luís Crisóstomo,Mário Sousa,Pedro F Oliveira,Marco G Alves,Caroline Burson
Environmental Epigenetics. 2020; 6(1)
[Pubmed] | [DOI]
16 Hyaluronan bound mature sperm count (HB-MaSC) is a more informative indicator of fertility than conventional sperm parameters: Correlations with Body Mass Index (BMI)
Miklos Szucs,Peter Osvath,Attila Jakab,Daniel Varga,Balazs Varga,Bela Juhasz
Reproductive Biology. 2019;
[Pubmed] | [DOI]
17 High-fat diets reduce male reproductive success in animal models: A systematic review and meta-analysis
Angela J. Crean,Alistair M. Senior
Obesity Reviews. 2019;
[Pubmed] | [DOI]
18 Effects of obesity on sperm retrieval, early embryo quality and clinical outcomes in men with nonobstructive azoospermia undergoing testicular sperm aspiration-intracytoplasmic sperm injection cycles
Fangyuan Li,Qingling Yang,Hao Shi,Hang Xin,Xiaoyan Luo,Yingpu Sun
Andrologia. 2019; : e13265
[Pubmed] | [DOI]
19 Impact of weight loss on sperm DNA integrity in obese men
J. Mir,D. Franken,S. W. Andrabi,M. Ashraf,K. Rao
Andrologia. 2018; : e12957
[Pubmed] | [DOI]
20 Association between BMI and semen quality: an observational study of 3966 sperm donors
Jixuan Ma,Li Wu,Yun Zhou,Hai Zhang,Chengliang Xiong,Zhe Peng,Wei Bao,Tianqing Meng,Yuewei Liu
Human Reproduction. 2018;
[Pubmed] | [DOI]
21 Effect of male body mass index on assisted reproduction treatment outcome: an updated systematic review and meta-analysis
Rabia Mushtaq,Jyotsna Pundir,Chiara Achilli,Osama Naji,Yacoub Khalaf,Tarek El-Toukhy
Reproductive BioMedicine Online. 2018;
[Pubmed] | [DOI]
22 The Role of Lifestyle in Male Infertility: Diet, Physical Activity, and Body Habitus
Russell P. Hayden,Ryan Flannigan,Peter N. Schlegel
Current Urology Reports. 2018; 19(7)
[Pubmed] | [DOI]
23 Obesity, male infertility, and the sperm epigenome
James R. Craig,Timothy G. Jenkins,Douglas T. Carrell,James M. Hotaling
Fertility and Sterility. 2017; 107(4): 848
[Pubmed] | [DOI]
24 American Society for Metabolic and Bariatric Surgery position statement on the impact of obesity and obesity treatment on fertility and fertility therapy Endorsed by the American College of Obstetricians and Gynecologists and the Obesity Society
Michelle A. Kominiarek,Emily S. Jungheime,Kathleen M. Hoeger,Ann M. Rogers,Scott Kahan,Julie J. Kim
Surgery for Obesity and Related Diseases. 2017;
[Pubmed] | [DOI]
25 Body mass index and human sperm quality: neither one extreme nor the other
E. M. Luque,A. Tissera,M. P. Gaggino,R. I. Molina,A. Mangeaud,L. M. Vincenti,F. Beltramone,J. Sad Larcher,D. Estof?n,M. Fiol de Cuneo,A. C. Martini
Reproduction, Fertility and Development. 2017; 29(4): 731
[Pubmed] | [DOI]
26 Association between body mass index and sperm quality and sperm DNA integrity. A large population study
J. B. A. Oliveira,C. G. Petersen,A. L. Mauri,L. D. Vagnini,A. Renzi,B. Petersen,M. Mattila,F. Dieamant,R. L. R. Baruffi,J. G. Franco
Andrologia. 2017; : e12889
[Pubmed] | [DOI]
27 Overweight in young males reduce fertility in rabbit model
Francisco Marco-Jiménez,José Salvador Vicente,Stefan Schlatt
PLOS ONE. 2017; 12(7): e0180679
[Pubmed] | [DOI]
28 Effect of paternal overweight or obesity on IVF treatment outcomes and the possible mechanisms involved
Qingling Yang,Feifei Zhao,Linli Hu,Rui Bai,Nan Zhang,Guidong Yao,Yingpu Sun
Scientific Reports. 2016; 6: 29787
[Pubmed] | [DOI]
29 Effects of female and male body mass indices on the treatment outcomes and neonatal birth weights associated with in vitro fertilization/intracytoplasmic sperm injection treatment in China
Xiaodan Wang,Jiayuan Hao,Fuli Zhang,Jing Li,Huijuan Kong,Yihong Guo
Fertility and Sterility. 2016;
[Pubmed] | [DOI]
30 Obesity and reproduction: a committee opinion
Fertility and Sterility. 2015; 104(5): 1116
[Pubmed] | [DOI]
31 No association between body mass index and sperm DNA integrity
I. Bandel,M. Bungum,J. Richtoff,J. Malm,J. Axelsson,H. S. Pedersen,J. K. Ludwicki,K. Czaja,A. Hernik,G. Toft,J. P. Bonde,M. Spano,G. Malm,T. B. Haugen,A. Giwercman
Human Reproduction. 2015; 30(7): 1704
[Pubmed] | [DOI]
32 Body Mass Index Is Associated with Impaired Semen Characteristics and Reduced Levels of Anti-Müllerian Hormone across a Wide Weight Range
Jorunn M. Andersen,Hilde Herning,Elin L. Aschim,Jøran Hjelmesæth,Tom Mala,Hans Ivar Hanevik,Mona Bungum,Trine B Haugen,Oliwia Witczak,Xuejiang Guo
PLOS ONE. 2015; 10(6): e0130210
[Pubmed] | [DOI]
33 Effect of male body mass index on clinical outcomes following assisted reproductive technology: a meta-analysis
W. Le,S.-H. Su,L.-H. Shi,J.-F. Zhang,D.-L. Wu
Andrologia. 2015; : n/a
[Pubmed] | [DOI]
34 Obesogenic Environment by Excess of Dietary Fats in Different Phases of Development Reduces Spermatic Efficiency of Wistar Rats at Adulthood: Correlations with Metabolic Status1
Vanessa Reame,Eloísa Zanin Pytlowanciv,Daniele Lisboa Ribeiro,Thiago Feres Pissolato,Sebastião Roberto Taboga,Rejane Maira Góes,Maria Etelvina Pinto-Fochi
Biology of Reproduction. 2014; 91(6)
[Pubmed] | [DOI]
35 The impact of male overweight on semen quality and outcome of assisted reproduction
Ralf Henkel,Kristian Leisegang
Asian Journal of Andrology. 2014; 16(5): 787
[Pubmed] | [DOI]
36 Limitations of semen analysis as a test of male fertility and anticipated needs from newer tests
Christina Wang,Ronald S. Swerdloff
Fertility and Sterility. 2014; 102(6): 1502
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Author Contributions
Competing Interests
Article Tables

 Article Access Statistics
    PDF Downloaded670    
    Comments [Add]    
    Cited by others 36    

Recommend this journal