The effect of bariatric surgery on male fertility outcomes including sex hormones, semen parameter and erectile function: A systematic review and meta-analysis

Abstract

Abstract Background: Obesity is linked to sexual dysfunction and infertility in both men and women because it causes changes in several sex hormones. Weight reduction, increased life expectancy, elimination, or improvement of most obesity-related medical complications, including diabetes, hypertension, hyperlipidaemia, and long-term efficacy, can be achieved by bariatric surgery leading to the best outcomes among obesity treatment options. However, the effects of bariatric surgery on sperm parameters and sex hormones in men are yet unknown. Aim: To assess the effect of bariatric surgery on male fertility outcomes, including sex hormones and semen parameters, as well as erectile function. Methods: A systematic review was performed to identify articles that measured fertility in men who had bariatric surgery using PubMed, Embase and MEDLINE databases from 1945 to 2021. The Review Manager and the Stata software were used to perform the statistical analysis. Mean differences (MDs) for continuous outcome variables with 95% confidence intervals (95% CIs) were used to pool data for standard meta-analysis and subgroup metaanalysis. Publication bias was evaluated using Egger`s test and considered positive if Prob > |z| less than 0.05. Results: A total of ten studies were included (320 participants) in this review. Overall, bariatric surgery was significantly increased the sex hormones. Total and free testosterone levels were shown to be significantly increased after bariatric surgery (P =0.00). Moreover, SHBG, LH, and FSH levels were also significantly increased after surgery (P <0.05) with a reduction in total estradiol (P = 0.00). However, a non-significant change in sperm volume and sperm viability, normal morphology, total motility, sperm concentration, progressive motility and total sperm count was observed (P >0.05). Moreover, the IIEF-5 non-significantly increased in obese men who underwent bariatric surgery (P=0.26). Conclusion: This systematic review and meta-analysis have shown that bariatric surgery significantly increases free and TT, SHBG, LH, and FSH, with decreases in TE levels after surgery. However, bariatric surgery did not show significant changes in semen parameters and erectile function.