Obesity Surgery

, Volume 29, Issue 7, pp 2045–2050 | Cite as

Lack of Improvement of Sperm Characteristics in Obese Males After Obesity Surgery Despite the Beneficial Changes Observed in Reproductive Hormones

  • Berniza Calderón
  • Lydia Huerta
  • Julio Galindo
  • José Manuel González Casbas
  • Héctor F. Escobar-Morreale
  • Antonia Martín-Hidalgo
  • José I. Botella-CarreteroEmail author
Original Contributions



Even though obesity surgery normalizes circulating testosterone concentrations in males with obesity-associated secondary hypogonadism, its impact on spermatogenesis remains controversial. We aimed to evaluate sperm characteristics in obese men after bariatric surgery as well as changes in reproductive hormones.


Twenty severely obese men (body mass index (BMI) ≥ 35 kg/m2) were evaluated before and 2 years after bariatric surgery. The serum was assayed for insulin, leptin, kisspeptin, and inhibin B, among other hormones. Homeostasis model assessment of insulin resistance (HOMA-IR) was estimated. We used World Health Organization reference values for sperm analysis.


After surgery, serum total testosterone, calculated free testosterone, inhibin B, and kisspeptin increased, whereas fasting insulin, HOMA-IR, and leptin concentrations decreased. Despite these improvements, sperm volume showed a small decrease after surgery, while the rest of sperm characteristics remained mostly unchanged. Abnormal sperm concentration persisted in 60% of the patients.


Sperm characteristics may not improve after bariatric surgery despite the beneficial changes of reproductive hormones.


Obesity Bariatric surgery Kisspeptin Leptin Semen analysis Male infertility 



We thank the nurses of the Department of Endocrinology and Nutrition for their help with the anthropometric measurements and blood sampling of the patients.


Supported by Grants PI18/00132, PI18/01122, and PI1600154 from Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness. Supported in part by the FondoEuropeo de Desarrollo Regional (FEDER) from the European Union. CIBERDEM and CIBEROBN are also initiatives of Instituto de Salud Carlos III. Dr. Calderón received a grant from MESCYT, Dominican Republic Ministry of Superior Education.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was obtained from all the participants included in the study.


  1. 1.
    Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of Obesity. N Engl J Med. 2017;376(3):254–66.CrossRefGoogle Scholar
  2. 2.
    Mongraw-Chaffin M, Foster MC, Anderson CAM, et al. Metabolically healthy obesity, transition to metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol. 2018;71(17):1857–65.CrossRefGoogle Scholar
  3. 3.
    Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.CrossRefGoogle Scholar
  4. 4.
    Hammiche F, Laven JS, Twigt JM, et al. Body mass index and central adiposity are associated with sperm quality in men of subfertile couples. Hum Reprod. 2012;27(8):2365–72.CrossRefGoogle Scholar
  5. 5.
    Samavat J, Natali I, Degl’Innocenti S, et al. Acrosome reaction is impaired in spermatozoa of obese men: a preliminary study. Fertil Steril. 2014;102(5):1274–81. e2CrossRefGoogle Scholar
  6. 6.
    Calderon B, Gomez-Martin JM, Vega-Pinero B, et al. Prevalence of male secondary hypogonadism in moderate to severe obesity and its relationship with insulin resistance and excess body weight. Andrology. 2016;4(1):62–7.CrossRefGoogle Scholar
  7. 7.
    Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10(7):653–62.CrossRefGoogle Scholar
  8. 8.
    Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefGoogle Scholar
  9. 9.
    Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55.CrossRefGoogle Scholar
  10. 10.
    Escobar-Morreale HF, Santacruz E, Luque-Ramirez M, et al. Prevalence of ‘obesity-associated gonadal dysfunction’ in severely obese men and women and its resolution after bariatric surgery: a systematic review and meta-analysis. Hum Reprod Update. 2017;23(4):390–408.CrossRefGoogle Scholar
  11. 11.
    di Frega AS, Dale B, Di Matteo L, et al. Secondary male factor infertility after Roux-en-Y gastric bypass for morbid obesity: case report. Hum Reprod. 2005;20(4):997–8.CrossRefGoogle Scholar
  12. 12.
    El Bardisi H, Majzoub A, Arafa M, et al. Effect of bariatric surgery on semen parameters and sex hormone concentrations: a prospective study. Reprod BioMed Online. 2016;33(5):606–11.CrossRefGoogle Scholar
  13. 13.
    Lazaros L, Hatzi E, Markoula S, et al. Dramatic reduction in sperm parameters following bariatric surgery: report of two cases. Andrologia. 2012;44(6):428–32.CrossRefGoogle Scholar
  14. 14.
    Legro RS, Kunselman AR, Meadows JW, et al. Time-related increase in urinary testosterone levels and stable semen analysis parameters after bariatric surgery in men. Reprod BioMed Online. 2015;30(2):150–6.CrossRefGoogle Scholar
  15. 15.
    Reis LO, Zani EL, Saad RD, et al. Bariatric surgery does not interfere with sperm quality—a preliminary long-term study. Reprod Sci. 2012;19(10):1057–62.CrossRefGoogle Scholar
  16. 16.
    Samavat J, Cantini G, Lotti F, et al. Massive weight loss obtained by bariatric surgery affects semen quality in morbid male obesity: a preliminary prospective double-armed study. Obes Surg. 2018;28(1):69–76.CrossRefGoogle Scholar
  17. 17.
    Sermondade N, Massin N, Boitrelle F, et al. Sperm parameters and male fertility after bariatric surgery: three case series. Reprod BioMed Online. 2012;24(2):206–10.CrossRefGoogle Scholar
  18. 18.
    Lee Y, Dang JT, Switzer N, et al. Impact of bariatric surgery on male sex hormones and sperm quality: a systematic review and meta-analysis. Obes Surg. 2019;29(1):334–346.Google Scholar
  19. 19.
    Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999;84(10):3666–72.CrossRefGoogle Scholar
  20. 20.
    Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRefGoogle Scholar
  21. 21.
    Cooper TG, Noonan E, von Eckardstein S, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231–45.CrossRefGoogle Scholar
  22. 22.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.CrossRefGoogle Scholar
  23. 23.
    Calderon B, Hevia V, Vega-Pinero B, et al. Serum retinol, folic acid, and copper are associated with sperm abnormalities in men with obesity. J Am Coll Nutr. 2018;37(3):194–200.CrossRefGoogle Scholar
  24. 24.
    Buchter D, Behre HM, Kliesch S, et al. Pulsatile GnRH or human chorionic gonadotropin/human menopausal gonadotropin as effective treatment for men with hypogonadotropic hypogonadism: a review of 42 cases. Eur J Endocrinol. 1998;139(3):298–303.CrossRefGoogle Scholar
  25. 25.
    Liu PY, Baker HW, Jayadev V, et al. Induction of spermatogenesis and fertility during gonadotropin treatment of gonadotropin-deficient infertile men: predictors of fertility outcome. J Clin Endocrinol Metab. 2009;94(3):801–8.CrossRefGoogle Scholar
  26. 26.
    Prior M, Stewart J, McEleny K, et al. Fertility induction in hypogonadotropic hypogonadal men. Clin Endocrinol (Oxf). 2018;89(6):712–8.CrossRefGoogle Scholar
  27. 27.
    Davidson LM, Millar K, Jones C, et al. Deleterious effects of obesity upon the hormonal and molecular mechanisms controlling spermatogenesis and male fertility. Hum Fertil (Camb). 2015;18(3):184–93.CrossRefGoogle Scholar
  28. 28.
    Khan SM, Hamnvik OP, Brinkoetter M, et al. Leptin as a modulator of neuroendocrine function in humans. Yonsei Med J. 2012;53(4):671–9.CrossRefGoogle Scholar
  29. 29.
    George JT, Millar RP, Anderson RA. Hypothesis: kisspeptin mediates male hypogonadism in obesity and type 2 diabetes. Neuroendocrinology. 2010;91(4):302–7.CrossRefGoogle Scholar
  30. 30.
    Xiang J, Bian C, Wan X, et al. Sleeve gastrectomy reversed obesity-induced hypogonadism in a rat model by regulating inflammatory responses in the hypothalamus and testis. Obes Surg. 2018;28(8):2272–80.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Berniza Calderón
    • 1
    • 2
  • Lydia Huerta
    • 3
    • 4
  • Julio Galindo
    • 5
  • José Manuel González Casbas
    • 6
    • 7
  • Héctor F. Escobar-Morreale
    • 1
    • 8
    • 9
  • Antonia Martín-Hidalgo
    • 3
    • 4
  • José I. Botella-Carretero
    • 1
    • 4
    • 9
    Email author
  1. 1.Department of Endocrinology and NutritionHospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)MadridSpain
  2. 2.Instituto Tecnológico de Santo Domingo (INTEC)Santo DomingoDominican Republic
  3. 3.Department of Biochemistry-ResearchHospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)MadridSpain
  4. 4.Centro de Investigación Biomédica en Red-Fisiopatología de Obesidad y Nutrición (CIBERobn)MadridSpain
  5. 5.Department of General and Digestive SurgeryHospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)MadridSpain
  6. 6.Unit of Assisted ReproductionHospital Universitario Ramón y CajalMadridSpain
  7. 7.European Institute of FertilityMadridSpain
  8. 8.Centro de Investigación Biomédica en Red-Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)MadridSpain
  9. 9.University of Alcalá de Henares (UAH)MadridSpain

Personalised recommendations