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Semen abnormalities persist in men after Roux-en-Y gastric bypass
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Men with obesity who undergo Roux-en-Y gastric bypass experience semen abnormalities in the 2 years after surgery despite improvements in androgenic profile and their sexual quality of life, according to findings published in Bariatric Surgical Practice and Patient Care.
“Altered semen characteristics correlated with BMI, and although bariatric surgery was effective in improving male hormones, semen parameters were apparently refractory,” Alberto Rosenblatt, MD, PhD, a postdoctoral fellow in the department of gastroenterology at Central Institute of Hospital das Clinicas in Sao Paulo, Brazil, and colleagues wrote. “More than 50% of bariatric patients displayed semen abnormalities, with a more disadvantageous pattern than obese controls.”
Rosenblatt and colleagues analyzed data from 79 sexually active men with or without type 2 diabetes who underwent Roux-en-Y gastric bypass surgery and were attempting to conceive with a partner. Patients were stratified into four groups: patients who underwent surgery with at least 5 years of follow-up (n = 23; mean age, 48 years), men who had undergone surgery within 1 or 2 years (n = 23; mean age, 35 years), men with overweight or obesity who did not undergo surgery (controls; n = 18; mean age, 34 years), and lean controls (n = 15; mean age, 35 years). Participants completed a sexual quality-of-life questionnaire and provided blood samples to assess glucose homeostasis, C-reactive protein, 25-hydroxyvitamin D, zinc, total testosterone, free testosterone, sex hormone-binding globulin (SHBG), estradiol, thyroid-stimulating hormone and thyroxin. Except for men in the long-term follow-up group, all men provided semen samples.
Compared with lean controls and controls with obesity, researchers found that total testosterone (P < .01), free testosterone (P = .03) and SHBG (P < .01) were all higher in men who underwent surgery. Sperm parameters were normal in 42.9% of men who recently underwent surgery compared with 66.7% of controls with obesity and 80% of lean controls. Semen abnormalities observed in men who underwent surgery within 1 or 2 years included oligoasthenoteratospermia (14.3%), oligospermia, asthenospermia, teratospermia and oligoasthenospermia (9.5%) and azoospermia (4.8%). BMI positively correlated with oligoasthenoteratospermia (P = .008). There were no between-group differences for gonadal status, which was not correlated with semen quality, according to researchers.
Vitamin D levels in both controls with obesity and men who underwent surgery were less than 30 ng/mL, whereas lean controls had normal vitamin D levels. Vitamin D levels negatively correlated with BMI (P < .01). Both groups who underwent bariatric surgery reported higher sexual quality-of-life scores after surgery when compared with scores before surgery.
“Hyperestrogenism and hipovitaminosis D, commonly observed in both obese and in bariatric male patients with weight regain or insufficient weight loss, might exert a negative influence on semen parameters, with possible detrimental effects on male reproduction,” Rosenblatt told Endocrine Today.
Estrogen levels in men who underwent bariatric surgery remained unchanged and in the same range as men with obesity who did not undergo surgery, the researchers noted.
“Severely obese men of reproductive age who choose bariatric surgery as treatment for their condition should be properly counseled about the possible impact of Roux-en-Y gastric bypass surgery on their fertility potential, at least in the short-term,” Rosenblatt said. “In addition, sex hormones and semen analysis should be routinely included in their pre- and post-operative evaluation.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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