Obesity and Impaired Male Fertility: An Association of Clinical Importance

Male infertility is a major contributor to couple infertility, and increasing evidence suggests that excess body weight may adversely affect semen quality. Obesity and overweight have been associated with hormonal imbalance, oxidative stress, and metabolic disturbances that may impair spermatogenesis. The aim of this study was to evaluate the association between body mass index (BMI) and semen abnormalities in infertile men.

We conducted a retrospective descriptive study over a period of two years, including 112 men who consulted for infertility at the Medically Assisted Reproduction Center of Mohammed VI University Hospital, Oujda, Morocco. Patients were classified into three BMI groups: normal BMI, overweight, and obese. Semen analysis was assessed according to World Health Organization criteria. Quantitative and qualitative semen abnormalities were recorded and compared across BMI groups. Statistical analysis was mainly performed using the chi-square test.

Among the 112 patients, 40 (35.7%) had a normal BMI, 52 (46.4%) were overweight, and 20 (17.9%) were obese. Normal semen parameters were more frequent in patients with normal BMI than in overweight and obese patients. Abnormal semen analyses were observed in 24 of 40 normal-BMI patients (60.0%), 46 of 52 overweight patients (88.5%), and 16 of 20 obese patients (80.0%). There was a statistically significant association between BMI category and semen analysis status (𝜒² = 10.42, p = 0.005). Pairwise analysis showed that the main difference was between normal-BMI and overweight patients (p = 0.003). Azoospermia was more frequent in overweight and obese patients than in normal-weight patients (21.2% and 25.0% vs. 15.0%), although this difference was not statistically significant (p = 0.611). Combined and more severe semen abnormalities were descriptively more frequent in patients with elevated BMI.

Excess body weight was associated with a higher frequency of abnormal semen parameters in this cohort of infertile men. Overweight and obese patients showed a greater burden of combined and severe semen abnormalities compared with patients with normal BMI. These findings support the role of BMI as a relevant clinical factor in the evaluation of male infertility and suggest that weight control may represent an important component of fertility-oriented management. Larger studies are needed to confirm these results and better define the relationship between overweight, obesity, and specific semen abnormalities.