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      Is low body mass index a risk factor for semen quality? A PRISMA-compliant meta-analysis

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          Abstract

          Background:

          Male infertility has become a worldwide public health problem. However, the effect of low body mass index (BMI) is still controversial.

          Methods:

          Relevant articles in Pubmed, Embase, Web of science, and Wanfang database published until September 2017 were searched without language restriction. We performed a meta-analysis about low BMI and semen parameters containing total sperm count, concentration, semen volume, and sperm motility (overall and progressive), including 709 men with low BMI and 14,622 men with normal BMI.

          Results:

          Thirteen studies were included in this meta-analysis and a total of 15,331 individuals were accumulated. We pooled data from these articles and found standardized weighted mean differences in semen parameters (total sperm count and semen volume) showed significant difference between low BMI and normal BMI.

          Conclusions:

          This systematic review with meta-analysis has confirmed that there was a relationship between low BMI and semen quality, which suggesting low BMI may be a harmful factor of male infertility. Yet lacking of the raw data may influence the accuracy of the results. Further researches are needed to identify the role of underweight in male sterility.

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          Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men.

          Grethe Andersen, Anne Andersson, Tina Kold Jensen … (2004)
          To examine the relationship between body mass index (BMI) and semen quality among young men from the general population. Cross-sectional study. Danish young men were approached when they attended a compulsory physical examination to determine their fitness for military service. From 1996-1998, 1,558 (19%) young men (mean age 19 years) volunteered. Semen volume (in milliliters), sperm concentration (in million per milliliter), percentage of motile spermatozoa, percentage of spermatozoa with normal morphology, total sperm count (in million), and testis size (in milliliters). In addition, serum reproductive hormones were measured. Serum T, sex hormone-binding globulin (SHBG), and inhibin B all decreased with increasing BMI, whereas free androgen index and E(2) increased with increasing BMI. Serum FSH was higher among slim men. After control for confounders, men with a BMI 25 kg/m(2) had a reduction in sperm concentration and total sperm count of 21.6% (95% CI 4.0%-39.4%) and 23.9% (95% CI 4.7%-43.2%), respectively, compared to men with BMI between 20-25 kg/m(2). Percentages of normal spermatozoa were reduced, although not significantly, among men with high or low BMI. Semen volume and percentage of motile spermatozoa were not affected by BMI. High or low BMI was associated with reduced semen quality. It remains to be seen whether the increasing occurrence of obesity in the Western world may contribute to an epidemic of poor semen quality registered in some of the same countries. If so, some cases of subfertility may be preventable.
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            Does weight loss improve semen quality and reproductive hormones? results from a cohort of severely obese men

            Linn Berger Håkonsen, Ane Marie Thulstrup, Anette Skærbech Aggerholm … (2011)
            Background A high body mass index (BMI) has been associated with reduced semen quality and male subfecundity, but no studies following obese men losing weight have yet been published. We examined semen quality and reproductive hormones among morbidly obese men and studied if weight loss improved the reproductive indicators. Methods In this pilot cohort study, 43 men with BMI > 33 kg/m2 were followed through a 14 week residential weight loss program. The participants provided semen samples and had blood samples drawn, filled in questionnaires, and had clinical examinations before and after the intervention. Conventional semen characteristics as well as sperm DNA integrity, analysed by the sperm chromatin structure assay (SCSA) were obtained. Serum levels of testosterone, estradiol, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH) and inhibin B (Inh-B) were measured. Results Participants were from 20 to 59 years of age (median = 32) with BMI ranging from 33 to 61 kg/m2. At baseline, after adjustment for potential confounders, BMI was inversely associated with sperm concentration (p = 0.02), total sperm count (p = 0.02), sperm morphology (p = 0.04), and motile sperm (p = 0.005) as well as testosterone (p = 0.04) and Inh-B (p = 0.04) and positively associated to estradiol (p < 0.005). The median (range) percentage weight loss after the intervention was 15% (3.5 - 25.4). Weight loss was associated with an increase in total sperm count (p = 0.02), semen volume (p = 0.04), testosterone (p = 0.02), SHBG (p = 0.03) and AMH (p = 0.02). The group with the largest weight loss had a statistically significant increase in total sperm count [193 millions (95% CI: 45; 341)] and normal sperm morphology [4% (95% CI: 1; 7)]. Conclusion This study found obesity to be associated with poor semen quality and altered reproductive hormonal profile. Weight loss may potentially lead to improvement in semen quality. Whether the improvement is a result of the reduction in body weight per se or improved lifestyles remains unknown.
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              Reverse causation and illness-related weight loss in observational studies of body weight and mortality.

              Jeffrey Williamson, Katherine Flegal, Amber Cooper … (2011)
              In studies of weight and mortality, the construct of reverse causation has come to be used to imply that the exposure-outcome relation is biased by weight loss due to preexisting illness. Observed weight-mortality associations are sometimes thought to result from this bias. Evidence for the occurrence of such bias is weak and inconsistent, suggesting that either the analytical methods used have been inadequate or else illness-related weight loss is not an important source of bias. Deleting participants has been the most frequent approach to control possible bias. As implemented, this can lead to deletion of almost 90% of all deaths in a sample and to deletion of more overweight and obese participants than participants with normal or below normal weight. Because it has not been demonstrated that the procedures used to adjust for reverse causation increase validity or have large or systematic effects on relative risks, it is premature to consider reverse causation as an important cause of bias. Further research would be useful to elucidate the potential effects and importance of reverse causation or illness-related weight loss as a source of bias in the observed associations between weight and mortality in cohort studies.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: August 2019
                Publication date (Electronic): 09 August 2019
                Volume: 98
                Issue: 32
                Electronic Location Identifier: e16677
                Affiliations
                [a ]Department of Preventive Health Branch, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing
                [b ]Reproductive Health and Infertility Clinic, Huai’an First People's Hospital, Nanjing Medical University, Huai’an
                [c ]Department of Gynaecology and Obstetrics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China.
                Author notes
                [∗ ]Correspondence: Jiazhen Dai, Department of Preventive Health Branch, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211166, China (e-mail: daijz2001@ 123456163.com ); Rong Ju, Department of Gynaecology and Obstetrics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing 211166, China (e-mail: 437710859@ 123456qq.com ).
                Article
                Publisher ID: MD-D-18-08906 Accession ID: 16677
                DOI: 10.1097/MD.0000000000016677
                PMC ID: 6709190
                PubMed ID: 31393367
                SO-VID: 7b50d07a-90fa-4c08-a05e-1d2e8115e9c7
                Copyright © Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                Date received : 3 January 2019
                Date revision received : 3 July 2019
                Date accepted : 8 July 2019
                Categories
                Subject: 7300
                Subject: Research Article
                Subject: Systematic Review and Meta-Analysis
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: low body mass index,meta-analysis,semen parameters,underweight
                Data availability:
                Keywords: low body mass index, meta-analysis, semen parameters, underweight

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