A Critical Analysis of the Evidence Regarding the Impact of Obesity on Male Fertility and Its Implications in Assisted Reproductive Technology Treatment. Literature Review
Abstract
Background:
Obesity is increasingly recognized as an important modifiable factor in male infertility. It may impair male
reproductive function through disruption of the hypothalamic–pituitary–gonadal axis, altered sex hormone balance,
insulin resistance, oxidative stress, chronic low-grade inflammation, increased scrotal temperature, and adipokine-
mediated effects, particularly involving leptin and inhibin B. These mechanisms may adversely affect
spermatogenesis, semen quality, sexual function, and outcomes of assisted reproductive technology treatment.
Methods:
This literature review critically analysed published evidence on the relationship between obesity and male fertility,
with particular focus on hormonal alterations, inflammatory pathways, oxidative stress, scrotal thermoregulation,
adipokines, and the implications of male obesity for assisted reproductive technology outcomes.
Results:
The evidence suggests that obesity negatively affects male fertility through multiple interacting mechanisms.
Increased aromatization of testosterone to oestrogen in adipose tissue may suppress gonadotropin-releasing
hormone, luteinizing hormone, and follicle-stimulating hormone secretion, resulting in reduced testosterone
production and impaired spermatogenesis. Obesity-associated insulin resistance and reduced sex hormone-binding
globulin further worsen androgen deficiency. Chronic inflammation, oxidative stress, raised scrotal temperature, and
elevated leptin levels may damage sperm membranes and DNA, impair sperm concentration, motility, morphology,
and reproductive potential. Evidence on the effect of male obesity on ART outcomes remains conflicting, although
some studies suggest poorer embryo quality and reduced clinical pregnancy and live birth rates.
Conclusion:
Obesity has a significant adverse impact on male reproductive health through hormonal, metabolic, inflammatory,
and oxidative mechanisms. It may contribute to male subfertility and may influence ART outcomes, although further
studies are needed to clarify the independent effect of male obesity after controlling for confounders such as female
BMI, age, and other causes of infertility.
Recommendation:
Men presenting for fertility care should be assessed for obesity and related metabolic risk factors. Weight
optimization, lifestyle modification, and management of obesity-related comorbidities should be incorporated into
preconception and fertility counselling. Further well-designed systematic studies meta-analysis are recommended
to better define the mechanisms linking obesity with impaired male fertility and to clarify its independent effect on
assisted reproductive technology outcomes
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Copyright (c) 2026 Dr Aloy UGWU Okechukwu, Sunday Isaac Omisakin, Kehinde Elizabeth Adeyemo, Adebayo Williams (Author)
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