Presentation Authors: Guilherme Wood*, Bruno Tiseo, Joao Paulo Cardoso, Hamilton de Martin, Marco Aurelio Santo, Miguel Srougi, Marcello Antonio Cocuzza, Sao Paulo, Brazil
Introduction: Despite the major importance of obesity as a global healthy issue, there is a paucity of data regarding its influence on male fertility. Bariatric surgery has become an important treatment option, but little is known of its impact on testicular and sexual function. This study aimed to evaluate the impact of obesity on erectile function, semen analysis (SA) and testicular function, and the influence of bariatric surgery in these parameters.
Methods: The study was performed on 2 phases. On the first phase 32 healthy fertile controls and 42 obese patients were submitted to complete urological evaluation, IEEF-5 score, SA and dosing of sexual hormones. On phase 2, 22 obese patients (Group A1) were submitted to bariatric surgery and 20 remained on conservative treatment (Group A2). Obese patients were then revaluated 6 months after surgery or after first evaluation. Parametric and non-parametric tests were applied as appropriate.
Results: On baseline, average age and body mass index on control group were 37.2 years and 27.4 kg/m2, and 42.1 years and 47.6 kg/m2 on obese patients. Seminal volume (2.9 vs. 1.5mL, p < 0.0001), sperm concentration (82.7 vs. 69.8 mi/mL, p=0.0422), progressive motility (49.1 vs. 30.4%, p=0.0003), and Kruger morphology (3.3 vs. 1.9%, p = 0.0141) were lower in obese patients. Sexual hormones evaluation showed higher estradiol (24.1 vs. 33.4 pg/mL, p=0.0042), LH (4.3 vs. 6.4 IU/L, p = 0.0004) and FSH (3.8 vs. 6.1 IU/L, p = 0.006) serum values on obese patients, while testosterone (T) levels were 30% lower on obese patients (423.9 vs. 299.2 ng/dL, p = 0.0001). IIEF-5 score was not different between groups.On Phase 2, mean weight loss on patients submitted to bariatric surgery was 38.2 kg (95% CI 33.4 - 43). Group A1 patients showed after 6-month follow-up a decrease on sperm concentration (53.5 vs. 105.2mi/mL, p = 0.0572), total ejaculated sperm count (58.2 vs. 169.8 mi, p = 0.0098) and total motile sperm count (34.5 vs. 104 mi, p = 0.0036). On the other side, T levels (648.9 vs. 291.1 ng/dL, p < 0.0001) and free T levels (276.2 vs. 183.7, p < 0.0001) dramatically increased after surgery, while FSH, LH and estradiol were not different from baseline. On group A2, no differences were observed on seminal parameters and sexual hormones after follow-up. IIEF-5 score showed no significant changes on both groups.
Conclusions: Obese patients have worse semen parameters, higher FSH, LH and estradiol levels, and lower T levels when compared to eutrophic fertile males. Bariatric surgery can increase T levels in 6-month follow-up; seminal parameters, however, may deteriorate after surgery.