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Impact of Body Mass Index Values on Sperm Quantity and Quality

From Reproductive Biology Associates, Atlanta, Georgia.

Correspondence to: Dr Hilton I. Kort, Reproductive Biology Associates, 1150 Lake Hearn Drive, Suite 400, Atlanta, GA 30342 (e-mail: roudebush{at}rba-online.com).

Received for publication July 20, 2005; accepted for publication November 21, 2005.

	Abstract

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Body mass index (BMI) has been demonstrated to affect female fertility; however, little information is available on the impact of BMI on male fertility or semen parameters. Therefore, the study objective was to determine the relationship between BMI and semen parameters, including sperm chromatin integrity. We analyzed data on semen samples from 520 men who were grouped based upon calculated BMI values (normal, 20-24 kg/m²; overweight, 25-30 kg/m²; obese, >30 kg/m²). The data collected included patient height and weight, semen volume, sperm concentration, percent sperm motility, percent sperm morphology (normal forms), and sperm chromatin integrity (DNA fragmentation index [DFI]). Data were analyzed by regression analysis and analysis of variance (ANOVA) with Tukey's test for multiple pairwise comparisons. The overall BMI mean (±SEM) was 27.5 (±0.49) kg/m². Linear regression revealed a significant (P < .05) and negative relationship between BMI and the total number of normal-motile sperm cells. ANOVA revealed a significant difference (P < .05) in the total number of normal-motile sperm cells among the different BMI groups. The number of normal-motile sperm cells per BMI group was as follows: normal, 18.6 x 10⁶; overweight, 3.6 x 10⁶; and obese, ^0.7 x 10⁶. All multiple pairwise comparisons were found to be significantly (P < .05) different. The overall DFI mean (±SEM) was 24.7 (±2.57). Linear regression revealed a significant (P < .05) and positive relation between BMI and DFI. Men presenting with a BMI greater than 25 kg/m² have fewer chromatin-intact normal-motile sperm cells per ejaculate. Therefore, to ensure maximum fertility potential, patients may be advised to reduce body weight.

     Key words: DNA, fertility, BMI

Little information exists on the impact of BMI on male fertility or semen parameters. Men with low BMI (<20 kg/m²) may present with an abnormal semen analysis and have low circulating testosterone levels (Ayers et al, 1985). However, this may be attributed to physical factors of training, for these individuals are typically athletes (Lucia et al, 1996). Our study objective was to determine the relationship between BMI and semen parameters (sperm quantity and quality) in the male partner of couples presenting for infertility.

	Materials and Methods

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Semen was collected by self-masturbation from normal, healthy men (age range, 26-45 years; mean, 34.6 years) presenting for routine semen analysis testing performed by the Reproductive Biology Associates Andrology Laboratory (Atlanta, Ga). A single semen sample was collected from each man. None of the men had previous surgery (eg, vasectomy reversal or varicocele removal). Patient height (m) and weight (kg) were recorded on the day of semen collection. BMI was calculated for each patient as kg/m². Patients were grouped according to published BMI ranges as follows: normal, 20-24 kg/m²; overweight, 25-30 kg/m²; and obese, greater than 30 kg/m².

Semen specimens were permitted to liquefy for 60 minutes at 37°C. Sperm concentration and percent motility was evaluated according to World Health Organization guidelines (WHO, 1999). An aliquot (50 µL) of semen was smeared and stained via the HEMA-3 (Fisher Scientific, Atlanta, Ga) staining procedure. In brief, slides were fixed (1.8 mg triarylmethane), stained in xanthene and thiazine (1.25 g/L each), rinsed in distilled water, and air dried. Smears were examined under oil immersion with bright light at 1000x. Each specimen had 200 cells systematically evaluated at the time of collection. Sperm morphology scores were determined by the Tygerberg "strict" criteria system (Kruger et al, 1986, 1988; WHO, 1999). The total number of normal-motile spermatozoa (NMS) for each patient semen specimen was calculated as NMS = volume x concentration x %motility x %morphology.

View larger version (9K): [in this window] [in a new window]   Figure 1. Effect of body mass index class on number of normal-motile sperm cells.

Data were analyzed by linear regression, analysis of variance (ANOVA), and Tukey's test for multiple pairwise comparisons. Statistical calculations were performed with SigmaStat for Windows, version 2.03 (Jandel Scientific Corporation, San Rafael, Calif).

	Results

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A total of 520 semen specimens were analyzed as described. There was no significant difference in patient ages among the different BMI groups. The overall BMI mean (±SEM) was 27.5 (±0.49) kg/m², which classifies the total group as overweight. Linear regression [NMS = (49.028) - (1.534 x BMI)] revealed a significant (P < .05) and negative relationship between BMI and NMS. ANOVA revealed a significant difference (P < .05) in the total number of normal-motile sperm cells among the 3 different BMI groups. The NMS per BMI group was as follows: normal, 18.6 x 10⁶ cells; overweight, 3.6 x 10⁶ cells; and obese, 0.7 x 10⁶ cells (Figure 1). All pairwise multiple comparisons (Tukey's test) were found to be significantly (P < .05) different. The overall DFI mean (±SEM) was 24.7% (±2.57%) kg/m². Linear regression [DFI = (1.145 ± BMI) - 6.079] revealed a significant (P < .05) and positive relation between BMI and DFI. The DFI per BMI group was as follows: normal, 19.9% (±1.96%); overweight, 25.8% (±2.23%); and obese, 27.0 (±3.16%) (Figure 2). A significant (P < .05) difference was found in DFI between the normal BMI group and both the overweight and obese groups. No significant difference was found between the overweight and obese groups with respect to sperm DFI.

View larger version (12K): [in this window] [in a new window]   Figure 2. Effect of body mass index class on sperm chromatin integrity. *Significantly different (P < .05).

	Discussion

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An inverse relationship between BMI and the total number of normal-motile sperm cells per subject was observed. Men with a BMI greater than 25 kg/m² have fewer normal chromatin-intact motile sperm cells per ejaculate. The excessive amount and distribution of body fat in female patients is related to fertility (Wass et al, 1997). High deposits of fat in the suprapubic and inner thigh areas may result in altered sperm production or chromatin integrity. Patients presenting with excess suprapubic fat have poor semen quality, which can be reversed with scrotal lipectomy (Shafik and Olfat, 1981). In addition to excess body fat, genetic and endocrinologic factors also may contribute to differences in sperm quality and quality observed.

Sperm chromatin is a highly organized and compact structure that maintains genetic integrity. Correlation studies have demonstrated the predictive nature of sperm chromatin structure on in vitro fertilization and intrauterine insemination outcomes. BMI has been demonstrated to affect female fertility (Wass et al, 1997). Overweight, infertile patients undergoing ART therapy typically require larger gonadotropin dosages (Loh et al, 2002), produce fewer mature oocytes (Crosignani et al, 1994), have lower embryo quality (Carrell et al, 2001), and have a higher incidence of miscarriages (Bellver and Pellicer, 2004). Men of infertile couples with high BMI values present with few normal-motile sperm cells. A positive relationship between BMI and DFI per subject was observed. As a man's BMI increases beyond 25 kg/m², his respective sperm DFI also increases. Typically, a man presenting with a DFI over 30 kg/m² will have reduced fertility with an increase of miscarriages (Gopalkrishnan et al, 2000; Bungum et al, 2004). Therefore, men of infertile couples with high DFI and high BMI may be advised to reduce body weight before any ART procedure. Additional studies are warranted to determine the impact BMI has on normal-motile sperm count and the impact DFI in fertile couples has upon male fertility and pregnancy outcomes.

	Conclusion

Top Abstract Materials and Methods Results Discussion Conclusion References

 
Men presenting with a BMI greater than 25 kg/m² have fewer chromatin-intact normal-motile sperm cells per ejaculate. Therefore, to ensure maximum fertility potential, patients may be advised to reduce body weight.

	References

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This Article Abstract Full Text (PDF) All Versions of this Article: 27/3/450    most recent Author Manuscript (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kort, H. I. Articles by Roudebush, W. E. Search for Related Content PubMed PubMed Citation Articles by Kort, H. I. Articles by Roudebush, W. E.