Department of Urology, University of California San Diego Health, San Diego, California.
Department of Urology, University of California San Diego Health, San Diego, California.
Fertil Steril. 2023 Dec;120(6):1098-1111. doi: 10.1016/j.fertnstert.2023.10.017. Epub 2023 Oct 14.
The impact of paternal obesity and metabolic disease on semen quality and fertility outcomes is not fully appreciated. With increasing obesity rates, researchers have studied the intricate relationship between paternal body mass index, metabolic health, and male fertility. This systematic review identified 112 articles in the MEDLINE database between 2013 and 2023 that investigated the effects of body mass index, diabetes, metabolic syndrome, exercise, weight loss medication, or bariatric surgery on semen parameters, sperm quality, or fertility outcomes. This review suggests that obesity, diabetes, and metabolic syndrome have a negative impact on various parameters of male fertility, from semen quality to sperm deoxyribonucleic acid integrity. There is also mounting evidence that male obesity is correlated negatively with live births via both natural conception and assisted reproductive technologies. Lifestyle interventions, such as physical exercise, generally appear to improve male fertility markers; however, the type and intensity of exercise may play a crucial role. Pharmacologic treatments for weight loss, such as metformin and glucagon-like peptide 1 agonists, present a more complex picture, with studies suggesting both beneficial and detrimental effects on male reproductive health. Similarly, surgical interventions, such as gastric bypass surgery, show promise in improving hormonal imbalances but have mixed effects on semen parameters. Future research is needed to clarify these associations and inform clinical guidelines. In the interim, health practitioners should incorporate these insights into clinical practices, encouraging proactive lifestyle changes and providing targeted treatments to improve male reproductive health.
父系肥胖和代谢疾病对精液质量和生育结果的影响尚未得到充分认识。随着肥胖率的上升，研究人员研究了父系体重指数、代谢健康和男性生育力之间复杂的关系。这项系统评价在 2013 年至 2023 年间从 MEDLINE 数据库中确定了 112 篇研究体重指数、糖尿病、代谢综合征、运动、减肥药物或减重手术对精液参数、精子质量或生育结果影响的文章。该综述表明，肥胖、糖尿病和代谢综合征对男性生育力的多个参数都有负面影响，从精液质量到精子脱氧核糖核酸完整性。越来越多的证据表明，男性肥胖通过自然受孕和辅助生殖技术与活产率呈负相关。生活方式干预，如体育锻炼，通常似乎可以改善男性生育力标志物；然而，运动的类型和强度可能起着关键作用。减肥的药物治疗，如二甲双胍和胰高血糖素样肽 1 激动剂，情况更为复杂，一些研究表明对男性生殖健康既有有益影响也有有害影响。同样，手术干预，如胃旁路手术，在改善激素失衡方面显示出希望，但对精液参数的影响喜忧参半。需要进一步的研究来阐明这些关联并为临床指南提供信息。在此期间，卫生保健工作者应将这些见解纳入临床实践，鼓励积极的生活方式改变，并提供有针对性的治疗，以改善男性生殖健康。
