Prevalence of poor semen parameters in men with metabolic syndrome


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Prevalence of poor semen parameters in men with metabolic syndrome

  1. 1. Dr Sathya Balasubramanyam MD,DNB,MRCOG,FNB(Reprod Med) Senior Consultant, Institute of Reproductive Medicine and Women’s Health, Madras Medical Mission, Chennai , India
  2. 2. A declining trend in semen parameters among fertile men in the last 20 years has been described.(Jouannet et al N Engl J Med Feb 1995)  Whether male infertility is actually increasing has still not been clearly established.  Lifestyle changes have been associated with male infertility- eg. smoking, sedentary lifestyle.
  3. 3.  Recent population-based studies suggest an elevated risk for subfertility among couples in which the male partner is obese and an increased likelihood of abnormal semen parameters among heavier men.  Fertil Steril. Hammoud Oct 2008.
  4. 4.  The metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure.  A quarter of the world’s adults have metabolic syndrome.  People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome.
  5. 5.  People with metabolic syndrome have a fivefold greater risk of developing type 2 diabetes.  This puts metabolic syndrome and diabetes way ahead of HIV/AIDS in morbidity and mortality terms yet the problem is not as well recognised.
  6. 6.  Aim: to assess the prevalence of metabolic syndrome in men with normal and abnormal semen parameters.  Setting: Institute of Reproductive Medicine.  Materials and Methods: 748 men underwent semen analysis in the infertility clinic from Aug 2009 till March 2010.  We have complete data to diagnose Metabolic syndrome in 526 men.
  7. 7. The men were assessed for the following parameters to diagnose metabolic syndrome  Waist circumference,  Blood Pressure,  Fasting Blood Sugar,  HDL and Triglycerides.  All of them underwent a Semen analysis in the same andrology lab. 
  8. 8.  Waist circumference >102 cm  Blood pressure >/= 130/85mmHg  Fasting Blood Glucose >/=110mg/dl  HDL < 40 mg/dl  Triglycerides >150 mg/dl
  9. 9.  Sperm concentration, total motility and morphology were assessed –  Concentration  Motility 40%  Morphology 4% 15 million/ml
  10. 10.  Mean age of men in our study was 34.3±3.4 years.  Proportion of abnormal semen parameters in men attending our infertility clinic was 241/526 (46%).  Number of men with metabolic syndrome was 136 (26.5 %).  Prevalence of Metabolic syndrome in men in Chennai 18%.  Sample size based on prevalence-248
  11. 11.  Number of men with metabolic syndrome and normal sperm parameters-79/285(27.7%)  Number of men with metabolic syndrome and abnormal sperm parameters-57/241(23.2%)  Chi square test showed that the difference was not statistically significant P=0.16
  12. 12.  Number of men with BMI>30 was 84/526(15.9%)  42/84 had abnormal semen parameters (50%).  Proportion of non obese men with abnormal semen parameters 199/442(45.02%)  Chi square test P=0.36  Number of men with BMI>35=13, all 13 had abnormal semen parameters.
  13. 13.  78/526 men had high abnormal waist circumference (15%). Population prevalence 20.8%.  46/241had waist >102cm and abnormal sperm parameters(19%).  32/285 had waist>102 cm and normal sperm parameters(11.2%).  P=0.15
  14. 14.  82/526 men had high fasting blood sugars (15.6%). Population prevalence 18.2%.  36 men had high fasting sugars and abnormal sperm parameters (14.9%)  46 men had high fasting sugars and normal sperm parameters (16.1%)  P=0.74
  15. 15.  249/526 men had abnormal triglyceride levels (47.3%). Population prevalence 32%.  105 men with high triglycerides had abnormal sperm parameters.  144 men with high triglycerides had normal sperm parameters.  P=0.272
  16. 16.  373/526 men had low HDL levels (70.9%).Population prevalence is 54.9%.  176 men had low HDL levels and abnormal sperm parameters.  197 men had low HDL levels and normal sperm parameters.  P=0.46
  17. 17.  138/526 men had BP>130/85(26.2%).Population prevalence 35%  71 men with high blood pressure had abnormal semen analysis 29.4%.  67 men had high blood pressure and normal sperm parameters 23.5%  P=0.27
  18. 18.  BMI was found to be unrelated to sperm concentration, motility and morphology by Chavarro et al in their study on 483 male partners of subfertile couples.(May 2010 FertilSteril)  Jensen et al found no dose response relationship between BMI and sperm concentration in their study 1158 young Danish military recruits(Fertil Steril 2004; 82:863-70).
  19. 19.  Magnusdottir et al found a statistically significant negative correlation between increasing BMI and sperm concentration in men with normal sperm concentration(Hum Reprod. 2005;20:208-15)  There are conflicting reports on the effect of BMI on sperm motility.
  20. 20.  There is no evidence currently of an effect of increasing BMI and abnormal sperm morphology.(Hammoud et al FertilSteril Oct 2008)  We could not find any studies assessing the effect of metabolic syndrome on sperm parameters.( according to the latest WHO 2010 GUIDELINES).
  21. 21.  In our study, 26% of men had metabolic syndrome was found to be higher than that in the general population 18%.  The prevalence of Metabolic syndrome was not significantly different in those with normal or abnormal semen parameters.
  22. 22.  Metabolic syndrome by itself does not appear to increase the chances of a man having abnormal sperm parameters.  Unlike in women, metabolic syndrome does not appear to have a major effect on fertility at least in the early stages.
  23. 23.  Longitudinal studies are needed to see if semen parameters tend to deteriorate over time in men with metabolic syndrome.  If not identified earlier on, morbid obesity could lead on to abnormalities in the semen analysis.  Population based studies would give a more accurate information on the effect of metabolic syndrome in men with respect to duration to conception.
  24. 24. THANK YOU