Original Article

Body Mass Index and Sperm Quality: Is there a Relationship?

Nataliia Mykhailivna Kozopas, Olga Ihorivna Chornenka1, Mykola Zinoviyovych Vorobets2, Lubov Yevhenivna Lapovets,
Hanna Vasylivna Maksymyuk

Departments of Clinical Context: Obesity and infertility are the major global public health problems.

Abstract
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Laboratory Diagnostics and

1
Urology, Danylo Halytsky
The evidences of adverse impact of adiposity on male fertility are contradictory.
Lviv National Medical Aim: The objective of the study was to determine the effect of overweight and
University, 2Medical Centre obesity on ejaculate quality, in particular, sperm parameters and biochemical
“Intersono Medicover markers. Subject and Design: The study involved 152 men who were distributed
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Group”, Lviv, Ukraine into three groups according to the body mass index (BMI, kg/m2): control
group with normal values (18.5–24.9), preobese (25.0–29.9), and obese (≥30.0).
Materials and Methods: Semen analysis included parameters: volume, sperm
concentration and total count, morphology, progressive (PR) and total motility.
Levels of fructose, citric acid, and zinc were measured in seminal plasma.
Statistic: The results of the studies were analyzed using StatPlus: mac (AnalystSoft
Inc., version 6). The Mann–Whitney U‑test was used to compare groups. Pearson’s
correlation coefficient was calculated. P < 0.05 was considered statistically
significant. Results: No significant differences of the semen parameters were
observed between preobese and control group, except for increasing the number
of abnormal spermatozoa. The obese group revealed lower concentration and total
number of sperm, PR motility. BMI was negatively correlated with most semen
parameters. The overweight group showed a decreasing of fructose levels and
increasing of citric acid and zinc concentration, while no significant changes were
observed in the obese group, except for a decreasing in fructose. Conclusions: The
present study confirms that with the growth of BMI, the sperm quality deteriorates.
Based on these results, we can assume that obesity may be an injurious factor of
male infertility.
Keywords: Body mass index, infertility, obesity, overweight, sperm

Introduction 2012.[2] The working group also analyzed the research

data which supported the potential influence of obesity
O besity and infertility are the major global public
health problems. In 2016, it was stated by the
World Health Organization (WHO) that 39% of the
on the reproductive function. Accordingly, it was
founded that supporting evidence of this theory was
population aged 18 years and older were overweight, conflicting. In particular, Sermondade et al.[3] suggest
and about 13% of the adults were obese. Notably, the that overweight and obesity in men was associated with
proportions of men in these two cases were 39% and rise of azoospermia and oligozoospermia, while one of
11%, respectively.[1] the largest meta‑analyses in this area by MacDonald

The exacerbation of this situation had led to the

development of a comprehensive guideline of male Address for correspondence: Dr. Nataliia Mykhailivna Kozopas,
Department of Clinical Laboratory Diagnostics, Danylo Halytsky
infertility which was prepared by the WHO in Lviv National Medical University, 69 Pekarska Str., 79010 Lviv,
Ukraine.
E-mail: [email protected]
Received: 03‑02‑2020 Revised: 19‑03‑2020
Accepted: 17‑04‑2020 Published: 09‑07‑2020 This is an open access journal, and articles are distributed under the terms of the Creative
Access this article online Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non-commercially, as long as appropriate credit is
Quick Response Code: given and the new creations are licensed under the identical terms.
Website:
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For reprints contact: [email protected]

DOI: How to cite this article: Kozopas NM, Chornenka OI, Vorobets MZ,
10.4103/jhrs.JHRS_15_20 Lapovets LY, Maksymyuk HV. Body mass index and sperm quality: Is there
a relationship? J Hum Reprod Sci 2020;13:110-3.

110 © 2020 Journal of Human Reproductive Sciences | Published by Wolters Kluwer - Medknow
 Kozopas, et al.: Body mass index and sperm quality

et al.[4] reports no correlation between body mass cells. Patients with leukospermia (>1 × 106/ml) and
index (BMI) with sperm concentration and sperm count. azoospermia were excluded from the study. The main
sperm parameters were determined using the sperm
However, the WHO experts strongly recommended
quality analyzer SQA‑V V. 2.47 (Medical Electronic
that men with fertility problems should be advised on
a weight loss strategy if their waist circumference and Systems Ltd, Caesarea Industrial Park, Israel).
BMI demonstrated the overweight or obesity.[2] Biochemical markers of seminal plasma were determined
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It is known that many infertile couples seek help by spectrophotometry using the biochemical analyzer
in specialized clinics. Today, the range of assisted BioSystem (Biosystems S.A., Barcelona, 2011) and
reproductive technologies is quite wide, but the included fructose,[11] citric acid,[12] and zinc.[13]
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effectiveness of their application depends on many Ethics

factors. In particular, research results have suggested We undersign, certificate that all the procedures and
that paternal obesity adversely affects clinical pregnancy experiments of this study respect the ethical standards in
rates after in vitro fertilization.[5,6] the Helsinki Declaration of 1975, as revised in 2008 (5),
In addition, recent studies have affirmed that weight loss as well as the national law.
in obese men is affiliated with an improvement in sperm Statistical analysis
parameters; however, it is difficult to investigate the The results of the studies were analyzed using
direct negative impact of BMI growth on the ejaculate StatPlus:mac LE software, version 6.1.25 (StatPlus:mac,
quality.[7,8] AnalystSoft Inc., 2016). The Mann–Whitney U‑test
Therefore, the aim of the presented work is to establish was used to compare groups. The data were expressed
the effect of overweight and obesity on sperm counts as median and range (minimum–maximum value).
and biochemical parameters of male ejaculate quality. Pearson’s correlation coefficient was also calculated. P <
Given the discrepancies in the results of various studies 0.05 was considered as statistically significant.
that inspected the effects of obesity on male fertility,[3,4]
and the tendency to decreasing in the sperm quality in Results
the population,[9] further investigations are required. This study involved 152 men, aged 21–53 years, who
The present work is aimed to establish the effect of were included in the control and two study groups,
overweight and obesity on sperm parameters and depending on the BMI. The clinical data and routine
biochemical markers which display the ejaculate quality. sperm parameters of the study groups are described in
Table 1.
Materials and Methods No significant differences of the semen parameters
Patients were observed between patients with overweight and
The study included 152 men who were observed for control group, except for an increasing in the number
infertility at a reproductive clinic during 2018. BMI of pathological forms of sperm. Whereas in the obesity
was computed for each patient (BMI, kg/m2). Based group revealed a significant deterioration of sperm
on these data, three groups were formed: normal quality, in particular, lower concentration and total
(18.5–24.9), overweight or preobesity (25.0–29.9), number of spermatozoa in ejaculate and lower PR
and obesity (≥30.0). Patients with any disorders of the motility.
reproductive system (congenital pathologies, varicocele, The biochemical analysis of seminal plasma [Table 2]
epididymitis, prostatitis, and postoperative conditions) in the preobesity group showed a decreasing of
were excluded from the study.
fructose levels (μmol/ejaculate) by 23% compared
Semen analysis to the control group (P < 0.05), increasing in citric
Semen samples were obtained by masturbation after acid (μmol/ejaculate) levels by 27%, and higher
2–7 days of sexual abstinence in a special clinic room. zinc concentration (μmol/L) by 20% compared to
The material was collected into sterile containers. the control group (P < 0.05). On the other hand, no
significant changes in biochemical parameters were
The ejaculate was evaluated after dilution in accordance
observed in the obesity group, except for a decreasing
to the WHO Guidelines 2010[10] and included
in fructose concentration compared to the control
parameters: volume, sperm concentration and total count,
group.
progressive (PR) and total motility (PR + nonprogressive),
immotile spermatozoa, percentage of normal Correlation analysis revealed a tendency for increasing
morphological forms, and concentration of white blood in BMI value with growing age of men (r = 0.36;

Journal of Human Reproductive Sciences ¦ Volume 13 ¦ Issue 2 ¦ April-June 2020 111

 Kozopas, et al.: Body mass index and sperm quality

Table 1: Clinical and main sperm parameters in groups

Parameters Control group (n=63) Preobesity (n=66) Obesity (n=23)
Age (years) 30.0 (21.0‑49.0) 31.5 (23.0‑56.0)* 37.0 (25.0‑53.0)*
BMI (kg/m2) 22.5 (18.5‑24.4) 27.7 (25.1‑29.8)* 33.0 (30.1‑41.1)*
Volume (mL) 4.2 (2.0‑8.5) 3.5 (1.0‑9.5) 3.0 (1.0‑9.5)
Sperm concentration (million/mL) 54.5 (6.0‑185.5) 44.5 (2.4‑269.0) 40.6 (2.5‑126.8)*
Total sperm count (million/ejaculate) 206.8 (15.0‑165.0) 136.1 (8.4‑1023.0) 120.6 (12.5‑378.0)*
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PR (%) 45.0 (27.0‑65.1) 45.0 (0‑63.6) 36.0 (0.8‑70.8)*

PR+NP (%) 57.2 (35.7‑82.5) 59.8 (12.5‑80.4) 51.0 (6.3‑85.4)*
IM (%) 42.8 (12.0‑76.1) 40.2 (17.9‑87.5) 49.0 (16.7‑93.8)*
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Sperm morphology (normal forms) (%) 30.0 (17.5‑64.4) 23.0 (4.0‑63.0)* 21.0 (5.0‑51.0)*
Data are expressed as median (range), *P<0.05. BMI: Body mass index, PR: Progressive motility, PR+NP: Total (progressive +
nonprogressive) motility, IM: Immotile spermatozoa

Table 2: Seminal biochemical parameters of studied group

Parameters Control group (n=63) Preobesity (n=66) Obesity (n=23)
Fructose (mmol/L) 18.2 (7.6‑44.6) 13.95 (3.5‑64.1)* 13.5 (2.6‑35.9)*
Fructose (µmol/ejaculate) 62.6 (22.0‑245.1) 53.4 (4.2‑256.4) 53.6 (18.4‑180.1)
Citric acid (mmol/L) 38.5 (7.41‑74.7) 49.0 (10.5‑209.0)* 39.9 (16.3‑71.1)
Citric acid (µmol/ejaculate) 153.0 (33.6‑462.0) 155.9 (21.0‑609.3) 201.6 (35.3‑665.0)
Zinc (µmol/L) 1417.0 (288.6‑4327.0) 1711.4 (411.0‑5817.0)* 1249.0 (525.0‑4115.0)
Data are expressed as median (range), *P<0.05

P < 0.05). In all patients, a BMI negatively correlated Interestingly, the rising concentration of seminal zinc
with concentration (r = −0.17; P < 0.05) and total was found only in the preobese group. Kasperczyk
number of spermatozoa in the ejaculate (r = 0.21; et al.[25] reported that the increasing zinc in seminal
P < 0.05), normal morphology (r = −0.27; P < 0.05), plasma is associated with an improvement of semen
and PR and total motility (r = 0.18, P < 0.05; r = −0.22, parameters. Obviously, this is due to the involvement
P < 0.05, accordingly). Levels of biochemical markers of zinc in the stabilization processes of membranes and
in seminal plasma did not significantly correlate with germ cells chromatin as well as due to zinc‑induced
BMI (P > 0.05 in all cases). reduction of the oxidative stress in overweight
men.[25,26]
Discussion
Since citric acid has antioxidant and anti‑inflammatory
This study showed that with the increase of BMI
functions in tissues damaged by environmental
and with the progress of adiposity, the quality of
factors,[27] we assume that increasing its concentration in
ejaculate significantly deteriorates, in particular, sperm
studied samples of preobese group was associated with
concentration, total number of spermatozoa and motility.
low‑grade systemic inflammation and oxidative stress.
Various studies have reported about negative correlation
An evaluation of the biochemical parameters of ejaculate
between obesity, increasing BMI, and basic sperm
such as fructose, citric acid, and zinc as markers of
parameters, including volume, sperm count, and motility.[14]
Jensen et al., 2004 and[15] Bieniek et al.[16] found that men accessory sex glands is necessary in further studies,
with obesity were more likely to have oligozoospermia and especially in the progression of adiposity.
azoospermia. Our findings also are consistent with recent
studies reporting an association of BMI with decreased
Conclusions
total sperm count[17‑19] and sperm motility.[16,20] The present study confirms that with the growth of BMI
the sperm quality deteriorates. Based on these results,
Preobese and obese men in this study had lower seminal we can assume that obesity may be an injurious factor of
fructose levels compared to men with normal weight. male infertility. Further studies are required to elucidate
However, data from numerous studies that evaluated the mechanism of negative impact of obesity on male
fructose concentration in seminal plasma are quite
reproductive function.
controversial. For example, Luque et al.[21] had reported
about reducing seminal fructose levels in morbidly obese Acknowledgments
men, and another studies have found a positive[22] or no We are grateful to Dr. Uliana Dorofeyeva, Medical
correlation of BMI with seminal fructose.[23,24] Director of Medical Centre “Intersono Medicover

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 Kozopas, et al.: Body mass index and sperm quality

Group,” for cooperation, and the laboratory staff from 13. Tetsuo M, Saito M, Horiguchi D, Kina K. A highly sensitive
this Center for their assistance in collecting the material colorimetric determination of serum zinc using water‑soluble
pyridylazo dye. Clin Chim Acta 1982;120:127‑35.
for research.
14. Kosopas NM, Maksymyuk GV, Lapovets LE, Odnorig LO.
Financial support and sponsorship Metabolic syndrome and male infertility: A modern look at the
problem. Bull Probl Biol Med 2018;1:26.
Nil.
15. Jensen T, Andersson A, Jorgensen N, Andersen A, Carlsen E,
Conflicts of interest Petersen J, et al. Body mass index in relation to semen quality
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and reproductive hormones among 1,558 Danish men. Fertil

There are no conflicts of interest. Steril 2004;82:863‑70.
16. Bieniek JM, Kashanian JA, Deibert CM, Grober ED, Lo KC,
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