Dr. Sharda Jain
Dr. Abhishek Singh Parihar
Dr. Yogesh Agarwala Bariatric
Surgeon
Dr. Jyoti Agarwal
Dr. Jyoti Bhaskar
Obesi...
Content
Epidemic of obesity
Obesity in India & it bad effects
is obese man at risk of infertility ?
What is the changes in...
Available on slideshare.net
Obesity Reduces
Fertility In Men
OBESITY
“AN EMERGING MENACE”
1. > 1 Billion overweight
2. > 300 Million – Obese
3. Obesity in men leading cause
of morbidi...
PREVALENCE OF OBESITY
is on increase!! ( 1986 – 2000 )
1. BMI > 30 kg / m2
- doubled
2. Morbid Obesity > 40 kg /m2
quadrup...
Obesity in Men & Women in
Reproductive Age in India
Country Male Female
India 9 12 (2000)
12 16 (2001)
Punjab 30 37.5
Gujr...
• BMI (Body Mass Index)
= Weight in kg / Height in M2
• Waist : Hip Ratio
Men > 0.88
Women > o.85
Quantification of Obesity
The measures may be even more
useful than BMI because of its
greater predictive value for future
health risk as well as ea...
BODY MASS INDEX
-2.5 in each category for
INDIANS (WHO)
Male Health & Obesity
Same or Different
Five Metabolic Abnormalities
Which effect Health Badly
MUO
METABOLICALY UNHEALTHY OBESITY
MUO is 2 or 2+ MHO 0-1 abnormality
MHO
METABOLICALY HEALTHY OBESITY
Obesity is The Root Cause of Some
of the Serious Diseases
Metabolic Disorders
• In Indians , types 2 diabetes and
hyperten...
Obesity is The Root Cause of Some
of the Serious Disease
CARDIOVASCULAR DISEASES
– Obese men have 30% higher
risk of death...
Morbid Obesity : Takes Heavy
Toll on men’s Health
- Globally . morbid obesity is responsible for the
following co-morbidit...
IMPACT OF OBESITY ON
LONGEVITY
• 2.5 million deaths attributed annually to
obesity
• In morbid obesity - life expectancy i...
OBESITY & PSYCHOSOCIAL
HEALTH in MEN
1. Poor body image
2. Social stigmatisation (‘a laughing matter’)
3. Lower education ...
Is obese men at risk of infertility
• An obese man is about twice
as likely to be infertile as a
normal man
Semen Count & ...
It is seen that
adolescent
obesity is
associated with a
threefold increase
risk of infertility
Is obese men at risk of inf...
Impacts
Fertility
Outcomes
Male
What are the changes in the semen
Indices of obese men?
• Decreased sperm count (oligozoospermia)
• Decreased sperm functi...
Semen Quality
The result regarding semen quality are
inconsistent in obese men
With some studies reporting a significant
a...
Idiopathic teratozoo spermia- unexplained
low concentration of
normal looking sperms
What are the changes in the semen
Ind...
• Idiopathic cryptozoospermia - absence of
sperm in routine semen analysis how ever
after centrifugation few sperms are se...
Sperm DNA Damage
• Studies on semen from Indian men &
Indian obese men have suggested that
spermatozoa from infertile men ...
All Possible factors
Contributing Infertility
• Decrease Sexual Activity
• Increase Eractile function
• Familial / Genetic...
Obesity and Infertility
spectrum of abnormalities
What are The Mechanism ?
There are three main
mechanisms involved:
1. Oxidative stress
2. Hormonal Imbalance
and hypogonad...
Other Possible mechanism
80% if both parents obese
10% if both parents are
normal weight
Hypothy. Cushing synd.
GH defi. E...
Possible Mechanism of
Infertility in Male Obesity
The Complex mechanism of obesity linking fat
excess to metabolic syndrom...
Leptin, adiponectin and resistin
involved in glucose metabolism, Sexual maturation and reproduction;
Excess leptin decreas...
Obesity, Metabolic Syndrome & Male
Male Infertility
Leptin inhibits testicular
steroidogenesis, decreasing
testosterone sy...
Treatment Modalities
Life – Style &
Nutrition
Changes
• Diet
• Exercise
• Psychological
Counseling
Surgical
Intervention
•...
Drugs
to decrease weight loss
• Decrease appetite
• Decrease fat absorption
Surgery
• Stomach volume Decrease – full feeli...
Word of caution
Prior to ART therapy
• Dietary weight loss, Regular physical
exercise , elimination of tabacco or alcohol
...
Does Weight Loss Improve
Semen Quality
YES
Changes based on % weight loss
Total sperm count (million)
Sperm DNA fregmentat...
Does Medication Improve semen Quality ?
Aromates Inhibitors for
Obesity – Related Male Infertility
Yes
It works
Aromatase inhibitors for
Obesity – Related Male Infertility
Male Hypogonadism
Recombinant hcg; 250 mcg per week; 12 weeks
Bariatric Surgery
A serious approach to serious problem
LAP Adjustable Gastric Banding
Given - up procedure in India
SLEEV...
Bariatric Surgery
A serious approach to serious problem
Literature is scanty
but does suggest that
sperm quality of
infert...
Obesity in Men & ART Techniques
• Few studies have shown decrease
likelihood of pregnancy in IVF cycles
• ICSI cycles prom...
4 cases (operated for Bariatric sugary)
Severe oligospermia 4/4
Failure to ejaculate 2/4
& failure to give specimen
EXPERI...
EXPERIENCE
• ICSI 2
• TESE – ICSI 2
• Gave success in 2/4 cases
Just like normal weight men
Take Home Messages
• Prevalence of obesity has doubled since 1970 s & so
is the infertility in obese men.
• Obesity decrea...
“Overweight and obese men
are more prone
to infertility”
• Article by Dr Abhishek S Parihar in
Economic times (28.5.14)
• ...
ADDRESS
11 Gagan Vihar, Near Karkari
Morh Flyover, Delhi - 51
CONTACT US
9650588339, 011-22414049,
WEBSITE :
www.lifecarec...
Thank You
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Obesity in male infertility by dr. sharda jain, Dr. Jyoti Agarwal, Dr. Jyoti Bhaskar , Adr. Abhishek Parihar, Dr. Yogesh Agarwal

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Obesity in male infertility by dr. sharda jain, Dr. Jyoti Agarwal, Dr. Jyoti Bhaskar , Adr. Abhishek Parihar, Dr. Yogesh Agarwal

  1. 1. Dr. Sharda Jain Dr. Abhishek Singh Parihar Dr. Yogesh Agarwala Bariatric Surgeon Dr. Jyoti Agarwal Dr. Jyoti Bhaskar Obesity Reduces Fertility In Men
  2. 2. Content Epidemic of obesity Obesity in India & it bad effects is obese man at risk of infertility ? What is the changes in semen ? What is the spectrum ? What is the mechanism ? What we can do about it ? ART in obesity Place of Beriatric surgery
  3. 3. Available on slideshare.net Obesity Reduces Fertility In Men
  4. 4. OBESITY “AN EMERGING MENACE” 1. > 1 Billion overweight 2. > 300 Million – Obese 3. Obesity in men leading cause of morbidity & mortality secondary to tobacco W H O
  5. 5. PREVALENCE OF OBESITY is on increase!! ( 1986 – 2000 ) 1. BMI > 30 kg / m2 - doubled 2. Morbid Obesity > 40 kg /m2 quadrupled 3. Super Obesity > 50 kg /m2 – five fold Increase Buchwald et al Surg for obesity & realated diseases(2005) 371-381
  6. 6. Obesity in Men & Women in Reproductive Age in India Country Male Female India 9 12 (2000) 12 16 (2001) Punjab 30 37.5 Gujrat 15 17 UP 16 12 Haryana 14 17
  7. 7. • BMI (Body Mass Index) = Weight in kg / Height in M2 • Waist : Hip Ratio Men > 0.88 Women > o.85 Quantification of Obesity
  8. 8. The measures may be even more useful than BMI because of its greater predictive value for future health risk as well as ease of measurements Men Waist = 40” (102 cm) Women Waist = 35” (88 cm) National Institute of Health Rockville: national institute of health . 2000.(publication no. 00-4084)
  9. 9. BODY MASS INDEX -2.5 in each category for INDIANS (WHO)
  10. 10. Male Health & Obesity Same or Different
  11. 11. Five Metabolic Abnormalities Which effect Health Badly
  12. 12. MUO METABOLICALY UNHEALTHY OBESITY MUO is 2 or 2+ MHO 0-1 abnormality MHO METABOLICALY HEALTHY OBESITY
  13. 13. Obesity is The Root Cause of Some of the Serious Diseases Metabolic Disorders • In Indians , types 2 diabetes and hypertension has a close link to obesity • 60 million people suffered from diabetes in 2012 and will exceed 100 million by 2030 • People with BMI >35.0 kg/m have a 6-fold higher risk of diabetes
  14. 14. Obesity is The Root Cause of Some of the Serious Disease CARDIOVASCULAR DISEASES – Obese men have 30% higher risk of death , due to – circulatory system diseases than normal weight individuals CANCER •Obese men have showed higher risk of cancer •Ostioarthritis, gall bladder disease, Asthma
  15. 15. Morbid Obesity : Takes Heavy Toll on men’s Health - Globally . morbid obesity is responsible for the following co-morbidities 7-41% of cancer cases like colon, rectum, kidney, pancreas etc 44% of diabetes cases 23%of ischemic heart disease cases Hyptension , dyslipidemia ,asthma., osteoarthritis gall bladder disease etc.
  16. 16. IMPACT OF OBESITY ON LONGEVITY • 2.5 million deaths attributed annually to obesity • In morbid obesity - life expectancy is reduced by 9 yrs in women 12 yrs in men Framingham dataFramingham data
  17. 17. OBESITY & PSYCHOSOCIAL HEALTH in MEN 1. Poor body image 2. Social stigmatisation (‘a laughing matter’) 3. Lower education levels 4. Lower rates of marriage 5. Lower socio economic levels
  18. 18. Is obese men at risk of infertility • An obese man is about twice as likely to be infertile as a normal man Semen Count & Quality has declined all over the world in last 4-5 decades. Possibly this trend corresponds with Global increase risk in obesity Yes Flegal et al. JAMA 2010,303,255-41
  19. 19. It is seen that adolescent obesity is associated with a threefold increase risk of infertility Is obese men at risk of infertility
  20. 20. Impacts Fertility Outcomes Male
  21. 21. What are the changes in the semen Indices of obese men? • Decreased sperm count (oligozoospermia) • Decreased sperm function
  22. 22. Semen Quality The result regarding semen quality are inconsistent in obese men With some studies reporting a significant association between overweight and low semen quality and Other studies reporting no association Jensen TK, andersson A.M jorgensen N, anderdsen A-G carlsen E, petersen JH et al. body mass index in relation to semen quality and reproductive hormones among 1,558 danish men. Fertil steril , 2004;
  23. 23. Idiopathic teratozoo spermia- unexplained low concentration of normal looking sperms What are the changes in the semen Indices of obese men?
  24. 24. • Idiopathic cryptozoospermia - absence of sperm in routine semen analysis how ever after centrifugation few sperms are seen. What are the changes in the semen Indices of obese men?
  25. 25. Sperm DNA Damage • Studies on semen from Indian men & Indian obese men have suggested that spermatozoa from infertile men possess more DNA damage those from fertile men • However the correlation with outcome in ART cycles (IUI & IVF) is not well established Venktesh et. al. Andrologia 2009; 41: 251-6
  26. 26. All Possible factors Contributing Infertility • Decrease Sexual Activity • Increase Eractile function • Familial / Genetic factor (possible) • Peripheral androgen aromatlzation is often increased in obese men thus altering HPG axis - & affects fertility potential
  27. 27. Obesity and Infertility spectrum of abnormalities
  28. 28. What are The Mechanism ? There are three main mechanisms involved: 1. Oxidative stress 2. Hormonal Imbalance and hypogonadism 3. Accumulation of infertility disruptors 4. Family Influence
  29. 29. Other Possible mechanism 80% if both parents obese 10% if both parents are normal weight Hypothy. Cushing synd. GH defi. Eating disorders, night eating syndrome
  30. 30. Possible Mechanism of Infertility in Male Obesity The Complex mechanism of obesity linking fat excess to metabolic syndrome are not well understood. Studies have suggested that the adverse effect of male obesity on semen parameters is mediated by serum leptin , altering intracellular metabolism and peripheral tissue receptors in leydig and germ cells Hofny ERM et. al. fertil steril.2010;94:581-4 Soyupek S. Arch Androl 2005:51;239-46
  31. 31. Leptin, adiponectin and resistin involved in glucose metabolism, Sexual maturation and reproduction; Excess leptin decreases leydig cell function ( ITT) And has a direct negative effect on sperm IL-6, IL -10 TNF a Increase No production and Oxidative stress Winters et al. Androl 2006; Jope et al.int J Androl 2003; Hofny et al. fertil sterile 2009;, Blalas et al. Am J Reprod immunol 2009; Fraczek & Kurpisc J androl 2007; Lamplao & du plessis reprod blomed online 2008 Possible Mechanism of Infertility in Male Obesity
  32. 32. Obesity, Metabolic Syndrome & Male Male Infertility Leptin inhibits testicular steroidogenesis, decreasing testosterone synthesis in leydig cell and inhibiting sperm maturation, as well as suppressing sertoli cell function Margetic S et al. int J obes Relat metab Disord 2002;26:1407-33
  33. 33. Treatment Modalities Life – Style & Nutrition Changes • Diet • Exercise • Psychological Counseling Surgical Intervention • Bariatric surgery ART • IUI • IVF • ICSI Pharmacological intervention Appetite suppressant, Weight Loss Drugs (Orlistat) Drugs Increase suicidal tendency
  34. 34. Drugs to decrease weight loss • Decrease appetite • Decrease fat absorption Surgery • Stomach volume Decrease – full feeling • Decrease bowel length- decrease absorption of nutrients
  35. 35. Word of caution Prior to ART therapy • Dietary weight loss, Regular physical exercise , elimination of tabacco or alcohol consumption, behavior modification and stress management may be of benefit • Weight loss should be the firstline treatment. Even 5% - 10% weight loss should improve fertility outcome. ESHRE human reproduction 2010;25:578-83
  36. 36. Does Weight Loss Improve Semen Quality YES Changes based on % weight loss Total sperm count (million) Sperm DNA fregmentation (%) TT (ng/dL) Hakonsen LB et al. Reprod Health, 2011
  37. 37. Does Medication Improve semen Quality ?
  38. 38. Aromates Inhibitors for Obesity – Related Male Infertility Yes It works
  39. 39. Aromatase inhibitors for Obesity – Related Male Infertility
  40. 40. Male Hypogonadism Recombinant hcg; 250 mcg per week; 12 weeks
  41. 41. Bariatric Surgery A serious approach to serious problem LAP Adjustable Gastric Banding Given - up procedure in India SLEEVE Gastrectomy & Gastric Bypass surgery are the only alternative & done routinely Safety of surgery in India – in good hands as safe as Lap. Cholecystectomy
  42. 42. Bariatric Surgery A serious approach to serious problem Literature is scanty but does suggest that sperm quality of infertile men improves in 6 months to 1 year.
  43. 43. Obesity in Men & ART Techniques • Few studies have shown decrease likelihood of pregnancy in IVF cycles • ICSI cycles promise good results
  44. 44. 4 cases (operated for Bariatric sugary) Severe oligospermia 4/4 Failure to ejaculate 2/4 & failure to give specimen EXPERIENCE
  45. 45. EXPERIENCE • ICSI 2 • TESE – ICSI 2 • Gave success in 2/4 cases Just like normal weight men
  46. 46. Take Home Messages • Prevalence of obesity has doubled since 1970 s & so is the infertility in obese men. • Obesity decreases semen count & quality. • In obese men - it cause metabolic co-morbidities like DM, Hypertension , increased cholesterol, hightriglocyte & raise mortality & morbidity significantly. • Wt loss is the key - - but very difficult • Medical treatment has a promise – needs further evaluation. • Pregnancy rate in obese men is highly subnormal in IVF cycles • However good result seen in ICSI cycles
  47. 47. “Overweight and obese men are more prone to infertility” • Article by Dr Abhishek S Parihar in Economic times (28.5.14) • http://economictimes.indiatimes.com/industry/h Dr Abhishek S Parihar Director Lifecare IVF
  48. 48. ADDRESS 11 Gagan Vihar, Near Karkari Morh Flyover, Delhi - 51 CONTACT US 9650588339, 011-22414049, WEBSITE : www.lifecarecentre.in www.drshardajain.com www.lifecareivf.com E-MAIL ID Sharda.lifecare@gmail.com Lifecarecentre21@gmail.com info@lifecareivf.com &
  49. 49. Thank You

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