Treatment of male infertility secondary to morbid obesity

Roth, Mara Y.; Amory, John K.; Page, Stephanie T.

doi:10.1038/ncpendmet0844

Cited by 95 publications

(64 citation statements)

References 15 publications

(1 reference statement)

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“…Indeed, increased aromatisation of androgens steroids to oestrogens in adipose tissue in obese men were described a few decades ago; increased oestrogen levels are known to induce hypogonadotropic hypogonadism with the end result of decreasing total and free testosterone (Schneider et al 1979). Anecdotally, treatment of an obese patient with the aromatase inhibitor anastrozole, led to decreased serum oestradiol levels, normalising luteinising hormone (LH) and testosterone levels, and restored spermatogenesis and fertility (Roth et al 2008). This observation supports the therapeutic potential of aromatase in infertile obese men, though the use of these drugs for this aim in clinical practice needs to be supported by further evidence that can also grant future label recommendation.…”

Section: Energy Balance Hormonal Dysfunction and Male Reproductionmentioning

confidence: 75%

Obesity, energy balance and spermatogenesis

Oliveira¹,

Sousa²,

Silva³

et al. 2017

Reproduction

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Obesity has grown to pandemic proportions. It affects an increasing number of children, adolescents and young adults exposed to the silent comorbidities of this disorder for a longer period. Infertility has arisen as one important comorbidity associated with the energy dysfunction promoted by obesity. Spermatogenesis is a highly regulated process that is determined by specific energetic requirements. The reproductive potential of males relies on hormonal-dependent and -independent stimuli that control sperm quality. There are conflicting data concerning the impact of male overweight and obesity on sperm quality, as well as on the possible paternal-induced epigenetic trait inheritance of obesity. In addition, it remains a matter of debate whether massive weight loss induced by lifestyle interventions, drugs or bariatric surgery may or may not benefit obese men seeking fatherhood. Herein, we propose to discuss how energy balance may modulate hormonal signalling and sperm quality in overweight and obese men. We also discuss some molecular mechanisms that mediate obesity-related dysfunction in male reproductive system and how paternal obesity may lead to trait inheritance. Finally, we will discuss how lifestyle modifications and sustained weight loss, particularly the loss achieved by bariatric surgery, may revert some of the deleterious effects of obesity in men and their offspring.Reproduction (2017) 153 R173-R185

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Section: Energy Balance Hormonal Dysfunction and Male Reproductionmentioning

confidence: 75%

Obesity, energy balance and spermatogenesis

Oliveira¹,

Sousa²,

Silva³

et al. 2017

Reproduction

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“…In fact, no malformed babies were fathered by infertile males in the course of this treatment. 4,12,13 Additional studies have also shown that letrozole does not increase the risk for congenital malformations with ovulation induction. 14 If our data are confirmed, this and future research may save some NOA patients from surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, aromatase inhibitors are believed to increase sperm count, androgen and gonadotropin levels and to lower blood E2 levels in oligoasthenoteratospermia patients. 12,13 Letrozole for non-obstructive azoospermia G Cavallini et al 896…”

Section: Discussionmentioning

confidence: 99%

Preliminary study of letrozole use for improving spermatogenesis in non-obstructive azoospermia patients with normal serum FSH

Cavallini

Beretta²,

Biagiotti³

2011

Asian J Androl

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We investigated whether letrozole (2.5 mg day 21 ) improves sperm count in non-obstructive azoospermia (NOA) patients. Four men were included in this study, and they had folliculo-stimulating hormone and other hormone levels within the normal range and no varicoceles or chromosomal aberrations. These four patients were administered letrozole for 3 months. Sperm count, testicular volume, gonadotropin, testosterone (T) and estradiol (E2) blood levels were assessed before, during and 1 week after the suspension of treatment. All patients showed spermatozoa in their ejaculate, increased gonadotropin and T levels and lower E2 levels (P,0.05 in all cases), when letrozole was administered. This suggests that letrozole treatment might improve sperm count in an NOA sub-population; however, more studies, including the proper controls, are needed to confirm its efficacy. Asian Journal of Andrology (2011) 13, 895-897; doi:10.1038/aja.2011.44; published online 27 June 2011Keywords: letrozole; medical treatment; non-obstructive azoospermia; spermatogenesis INTRODUCTION Azoospermia indicates the absence of spermatozoa in the ejaculate after two assessments of centrifuged semen. Its prevalence is about 1% in the general population and 10%-15% in infertile couples. 1 Azoospermia is classified as obstructive (OA) or non-obstructive (NOA). NOA is defined by the clinical evidence of strongly affected spermatogenesis, and OA results from a seminal-tract obstruction. Men with OA typically have normal-sized testes, possible epididymal fullness and normal serum follicle-stimulating hormone (FSH) levels. Men with NOA present frequently with small testes and an elevated FSH level; however, a minority of these men have normal testicles and FSH levels within the normal range. 2 Only men with hypogonadotropic-hypogonadism NOA or varicocele-associated NOA may yield spermatozoa in their ejaculate after treatment; however, the majority of men with NOA and normal or elevated FSH levels are only able to father children after surgical retrieval of the spermatozoa from the testicles, which is performed by testicular sperm extraction (TESE) or with fine-needle aspiration (FNA). TESE and FNA yield spermatozoa in 30%-60% of cases depending on the technique used. 1 Patry et al. 3 recently reported one case of hypospermatogenesis (having FSH levels within the normal range), which was converted to active spermatogenesis after letrozole (Femara; Sanofi-Novartis, Paris, France) use. However, the patient remained azoospermic due to an obstruction in the epididymis that was not adequately assessed when surgery was performed. Saylam et al. 4 recently treated 17 NOA patients who had low (,10) testosterone (T)/estradiol (E2) ratios with letrozole. Four of these men showed spermatozoa in their ejaculate after 6 months of therapy.

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“…86 This dysregulation is explained by the increased activity of aromatase cytochrome P450 enzyme, which is highly expressed in white adipose tissue. 85,87 This enzyme plays a key role in the biosynthesis of estrogen, and obese males have a high rate of conversion of androgens into estrogen due to a high bioavailability of aromatase enzymes. 87 Animal models have shown that high estrogen levels have a direct deleterious impact on spermatogenesis.…”

Section: Discussionmentioning

confidence: 99%

“…85,87 This enzyme plays a key role in the biosynthesis of estrogen, and obese males have a high rate of conversion of androgens into estrogen due to a high bioavailability of aromatase enzymes. 87 Animal models have shown that high estrogen levels have a direct deleterious impact on spermatogenesis. 88 Moreover, estrogen negatively regulates the secretion of gonadotropin-releasing hormone, luteinizing hormone, and follicle-stimulating hormone by the anterior pituitary gland.…”

Section: Discussionmentioning

confidence: 99%

Nutritional modifications in male infertility: a systematic review covering 2 decades

et al. 2015

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Context: Studies suggest that appropriate nutritional modifications can improve the natural conception rate of infertile couples. Objectives: The purpose of this study was to review the human trials that investigated the relation between nutrition and male infertility. Data Sources: A comprehensive systematic review of published human studies was carried out by searching scientific databases. Article selection was carried out in accordance with Preferred Reporting Items for Systematic Reviews and MetaAnalyses. The American Dietetic Association Research Design and Implementation Checklist was also used for quality assessment. Data Extraction: A total of 502 articles were identified, of which 23 studies met the inclusion criteria. Data Synthesis: Results indicated that a healthy diet improves at least one measure of semen quality, while diets high in lipophilic foods, soy isoflavones, and sweets lower semen quality. Conclusion: The role of daily nutrient exposure and dietary quality needs to be highlighted in male infertility. Mechanistic studies addressing the responsible underlying mechanisms of action of dietary modifications are highly warranted.

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Treatment of male infertility secondary to morbid obesity

Cited by 95 publications

References 15 publications

Obesity, energy balance and spermatogenesis

Obesity, energy balance and spermatogenesis

Preliminary study of letrozole use for improving spermatogenesis in non-obstructive azoospermia patients with normal serum FSH

Nutritional modifications in male infertility: a systematic review covering 2 decades

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