The influence of different bariatric surgeries on male sex hormones and parameters among infertile men with obesity

The influence of different bariatric surgeries on male sex hormones and parameters among infertile men with obesity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The influence of different bariatric surgeries on male sex hormones and parameters among infertile men with obesity Mahmoud Azhary, Mohamed Hassan Ali, Mohamed Ahmed Abd Elsalam, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8293620/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Obesity negatively impacts male fertility through hormonal disturbances and deteriorated semen parameters. Metabolic and bariatric surgery (MBS) offers sustained weight loss and potential reversal of these abnormalities. Methods This prospective case series included 43 with severe obesity infertile men who underwent sleeve gastrectomy, One-anastomosis gastric bypass (OAGB), or Roux-en-Y gastric bypass. All participants had a BMI ≥ 35 kg/m² and a history of infertility for over one year. Semen analysis and hormonal profiling (FSH, LH, total testosterone, estradiol [E2], and prolactin) were conducted preoperatively and at 3, 6, and 12 months postoperatively. Results Significant weight loss was observed at all follow-up points (p < 0.001). Improvements were noted in semen motility, progressive motility, vitality, and abnormal forms (all p < 0.001). Serum testosterone levels increased, while estradiol levels decreased significantly (p < 0.001). Changes in FSH, LH, and prolactin were statistically insignificant. Conclusion Metabolic and bariatric surgery (MBS) is associated with marked improvements in semen quality and serum testosterone levels, supporting its role as an effective therapeutic strategy for obesity-related male infertility. Obesity metabolic and bariatric surgery (MBS) one-anastomosis gastric bypass (OAGB) Roux-en-Y gastric bypass (RYGB) Figures Figure 1 Figure 2 Figure 3 1. Introduction Obesity affects over 650 million adults worldwide and is recognized as a modifiable risk factor for male infertility [ 1 ]. Excess adiposity promotes aromatization of testosterone to estradiol, leading to hypogonadotropic hypogonadism and impaired spermatogenesis [ 2 ]. Large cohort studies have shown a dose-dependent relationship between body mass index (BMI) and sperm DNA fragmentation, although findings on conventional semen parameters remain inconsistent [ 3 , 4 ]. Lifestyle modification offers modest improvements, whereas metabolic and bariatric surgery (MBS) achieves sustained weight loss and may reverse obesity-related reproductive dysfunction [ 5 ]. Excess adiposity impairs spermatogenesis through hormonal dysregulation, systemic inflammation, and oxidative stress [ 6 – 9 ]. Yet, associations between BMI and semen parameters remain heterogeneous, reflecting the multifactorial nature of obesity-related infertility [ 10 , 11 ]. While lifestyle interventions provide limited benefit, MBS represents a more effective and durable option [ 12 , 13 ]. Multiple bariatric procedures have been developed, including Roux-en-Y gastric bypass, adjustable gastric banding, biliopancreatic diversion with duodenal switch, and sleeve gastrectomy. Patient selection criteria were established by the National Institutes of Health (NIH) in 1991 and remain the standard, typically applied to individuals aged 18–60 years who commit to long-term follow-up [ 14 , 15 ]. Bariatric surgery promotes weight loss through restriction of intake and/or malabsorption [ 16 ]. Obesity contributes to multiple comorbidities, including infertility [ 17 ]. In women, hormonal imbalances and menstrual irregularities are key factors, while in men, impaired sperm quality and hormonal disturbances predominate. Non-surgical weight loss can improve reproductive parameters, but MBS is more effective, particularly in those with severe obesity [ 5 ]. This study evaluates the effects of MBS on serum sex hormone levels and semen parameters in infertile men with obesity 2. Methodology 2.1 Study Design and Setting This was a single-center, prospective observational case series of 43 men with obesity, conducted at a tertiary university hospital between January 2020 and December 2023. Patients were not randomized but underwent metabolic and bariatric surgery (MBS) according to clinical indications and surgeon preference. To reduce confounding across procedures—sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB)—patients were matched post hoc for age (± 3 years), baseline body mass index (BMI; ±2 kg/m²), and type of infertility (primary vs. secondary). The primary outcome was change in semen parameters (motility, vitality, concentration, morphology) and serum sex hormones (total testosterone, follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol [E2], prolactin) at 3, 6, and 12 months post-surgery. Secondary outcomes included BMI and metabolic markers. The study followed the STROCSS 2021 guidelines [ 18 ]. Randomization was not feasible due to clinical heterogeneity; however, baseline characteristics were balanced across subgroups [ 19 , 20 ]. 2.2 Participant Characteristics Of 68 eligible men, 43 met inclusion criteria and consented to participate (rate: 63.2%) (Fig. 1 ). Inclusion criteria: men with obesity aged 16–65 years, with primary or secondary infertility, surgically fit, and committed to long-term follow-up. Exclusion criteria: prior abdominal/pelvic surgery, radiotherapy or chemotherapy, leukocytospermia, uncontrolled medical conditions, heavy smoking, clinical or subclinical varicocele, testicular atrophy (< 12 mL), structural genital pathology, psychological/sexual dysfunction, sleep disorders, or female-factor infertility. Varicocele was defined clinically or by Doppler ultrasound [ 21 ]. Reasons for exclusion were female-factor infertility (n = 12), varicocele (n = 6), prior surgery (n = 4), and uncontrolled comorbidities (n = 3). 2.3 Intervention Preoperative evaluation: Included medical history, demographics, comorbidities, and investigations. Written informed consent was obtained. Laboratory and imaging: Standard labs (CBC, FBS, HbA1c, liver and renal profile, coagulation tests), abdominal ultrasound, chest X-ray, and ECG. Semen analysis: Collected after 2–7 days abstinence, with two samples averaged. Processing followed WHO 6th edition [ 22 ]. Motility, morphology (Tygerberg criteria, < 4% normal forms abnormal), and vitality (eosin-nigrosin stain) were assessed. All analyses were performed by one blinded embryologist. Hormone profile: FSH, LH, testosterone, prolactin, and estradiol were measured by chemiluminescent immunoassay (Cobas e601, Roche Diagnostics). Inter-assay CV < 8%. SHBG was measured; free testosterone calculated using the Vermeulen equation. Scrotal ultrasound: Evaluated testicular volume and pathology. Only men with normal architecture and bilaterally measurable testes were included. Surgical procedures: All laparoscopic under general anesthesia. SG: 36 Fr bougie, 4 cm proximal to pylorus. OAGB: 200 cm biliopancreatic limb, 300 cm common channel. RYGB: 75 cm biliopancreatic limb, 100 cm alimentary limb. Postoperative care: Early mobilization, PPIs for 6–8 weeks, gradual diet progression (liquid → soft → regular). Standard multivitamin supplementation included Centrum Silver®, vitamin D, calcium carbonate, B-complex, and whey protein. Antioxidants and fertility supplements were prohibited unless medically indicated. Follow-up: At 3, 6, and 12 months, patients underwent physical exam, semen analysis, and hormone testing. Primary measures: semen quality and hormonal profile. Secondary: BMI. 2.4 Statistical Analysis Changes in semen and hormones were analyzed with linear mixed-effects models including fixed effects (time, age, baseline BMI, procedure) and random intercepts. Bonferroni correction was applied. Effect sizes reported with 95% confidence intervals. Sensitivity analyses excluded three patients with transient semen deterioration. Analyses were performed with SPSS v28 and R v4.3.1. Sample size: No a priori calculation; exploratory design. With 43 participants and expected effect size (Cohen’s d ≥ 0.6), the study achieved > 80% power for testosterone changes at α = 0.05. 2.5 Ethical Considerations The protocol was approved by the institutional research ethics committee (MD-296-2021). Written informed consent was obtained. Data confidentiality was maintained in accordance with the Declaration 3. Results The majority of participants had primary infertility (65.1%), while 34.9% had secondary infertility. Most underwent sleeve gastrectomy (65.1%), with smaller groups receiving OAGB (16.3%) or RYGB (18.6%) ( Table 1 , Fig. 1 ). Mean BMI decreased significantly from 59.9 kg/m² preoperatively to 30.4 kg/m² at 12 months post-surgery (p < 0.001) ( Table 2 ). Semen parameters improved significantly in motility, vitality, and progressive motility (all p < 0.001), while sperm concentration showed no significant change (p = 0.991) ( Table 3 , Fig. 2 ). Three patients (7.0%) experienced transient declines in semen quality between 6 and 9 months, including one with severe oligoasthenoteratozoospermia. None developed azoospermia. Borderline deficiencies in zinc (n = 2) and selenium (n = 1) were corrected, and semen parameters stabilized or improved by 12 months. Serum total testosterone increased significantly, while estradiol declined markedly (both p < 0.001). No significant changes were observed in FSH, LH, or prolactin ( Table 4 , Fig. 3 ). Clinical Relevance This study evaluated infertile men with obesity and no prior bariatric surgery. A mean BMI reduction of nearly 30 kg/m² was achieved within 12 months, moving participants from severe obesity to overweight or moderate obesity. This reduction lessens obesity-related health risks, including impaired fertility. MBS improved semen quality—particularly motility and vitality—and produced favorable hormonal changes, with higher testosterone and lower estradiol. Sperm concentration remained stable, though abnormal forms decreased slightly, suggesting potential morphological recovery. Improvements may result from reduced oxidative stress and restored androgen–estrogen balance. Gonadotropins (FSH, LH) showed minimal nonsignificant changes, suggesting that improvements were not primarily mediated by hypothalamic-pituitary regulation. Stable prolactin levels further support this. The significant reduction in estradiol appears central to restoring hormonal equilibrium and enhancing fertility potential. Collectively, these findings indicate that MBS positively influences reproductive physiology in men with obesity by improving functional sperm quality and endocrine profiles (Figs. 2 and 3 ). 4. Discussion This prospective study demonstrates that metabolic and bariatric surgery (MBS) is associated with significant improvements in reproductive hormones and semen quality among men with obesity and infertility. Notably, sperm motility, progressive motility, and vitality improved alongside higher testosterone and reduced estradiol. These findings are consistent with prior studies by El Bardisi et al. [ 23 ] and Wood et al. [ 11 ], although sperm concentration did not significantly change in our cohort. This suggests that functional aspects of sperm quality may be more responsive to hormonal and metabolic recovery than sperm quantity. When comparing procedures, participants who underwent one-anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) experienced greater reductions in estradiol and more pronounced improvements in motility compared with those who underwent sleeve gastrectomy (SG). These findings may reflect the additional metabolic effects of intestinal rerouting and highlight the potential reproductive advantages of bypass procedures. Our results differ from a previously reported case series in which some men experienced deterioration in semen quality following surgery [32]. In contrast, semen parameters in our cohort improved progressively over 12 months, with only transient declines observed in a minority of participants. These short-term changes underscore the importance of postoperative nutritional monitoring, as rapid weight loss and malabsorption can contribute to micronutrient deficiencies (e.g., zinc, selenium, folate) or toxin release, which may adversely affect spermatogenesis despite improved endocrine profiles. The strengths of this study include its prospective design, direct comparison of three commonly performed procedures, and exclusive focus on men with infertility—a group underrepresented in previous research. Limitations include the absence of a non-surgical control group and reliance on semen analysis rather than clinical fertility outcomes. Future research should incorporate randomized controlled trials comparing MBS with lifestyle-based interventions and should evaluate pregnancy and live birth outcomes. In conclusion, MBS improves sperm motility, vitality, and hormonal balance in men with obesity and infertility, though sperm concentration appears largely unchanged. These findings support bariatric surgery as a potential strategy to improve male reproductive health, while emphasizing the need for ongoing nutritional surveillance and further investigation into long-term fertility outcomes 5. Conclusion Metabolic and bariatric surgery (MBS) is associated with significant improvements in sperm motility, vitality, and serum testosterone levels among men with obesity and infertility, while sperm concentration remains unchanged. These findings suggest that MBS enhances functional aspects of sperm quality and restores hormonal balance, potentially improving fertility potential. However, the absence of pregnancy and live birth outcomes limits definitive conclusions regarding fertility restoration. MBS should therefore be considered as one component of a comprehensive management strategy for men with obesity-related infertility, with further investigation needed to clarify its long-term reproductive impact. Limitations This study has several limitations. First, it was a single-center prospective case series without a control group, which restricts causal interpretation. Second, the sample size was modest, particularly for subgroup analyses. Third, advanced assessments of sperm function—such as DNA fragmentation, oxidative stress markers, and epigenetic parameters—were not performed, despite their relevance to reproductive outcomes. Fourth, although abstinence periods and seasonal variation were standardized, residual variability may have influenced semen parameters. Fifth, while participants received standardized postoperative care, unmeasured lifestyle changes could have contributed to observed improvements. Sixth, fertility outcomes—including pregnancy and live birth—were not evaluated. Finally, although participants were advised to avoid fertility-enhancing supplements, minor unreported use cannot be fully excluded, though it was unlikely to alter group-level results. Future multicenter randomized controlled trials with larger cohorts, longer follow-up, and incorporation of advanced sperm function testing are needed to better define the role of MBS in male reproductive health. Abbreviations MBS: Metabolic and bariatric surgery. NADPH; Nicotinamide Adenine Dinucleotide Phosphate enzyme. SHBG; Sex hormone-binding globulin. TT; Total testeron. FT; Free testeron. PPIs; Proton pump inhibitors. AZF; Azoospermia Factor RYGB; A Roux-en-Y gastric bypass. SG; Sleeve gastrectomy (SG). OAGB; One anastomosis gastric bypass. VSG; Vertical Sleeve Gastrectomy. ICSI: Intra-cytoplasmic sperm injection. OAT: Oligoasthenoteratozoospermia. Declarations Ethics approval and consent to participate The study protocol was approved by the Research Ethics Committee, Faculty of Medicine, Cairo University (Kasr Al-Ainy) (Approval number: MD-296-2021 ). Written informed consent was obtained from all participants prior to enrollment. All procedures performed in this study were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki . Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Due to privacy and ethical restrictions, the data are not publicly available. Competing interests The authors declare that they have no competing interests. Funding This research received no external funding . Authors’ contributions Mahmoud Azhary and Ehab Fathy conceived the study and collected data. Mahmoud Azhary and Mohamed Elshal developed the methodology. Ahmed Tarek Mohamed and Ahmed Maher Abdelmonim contributed to writing, editing, and software analysis. Ahmed Mohamed Salah Eldeen Othman Elansary contributed to review and funding support. Mohamed Ahmed Abdelsalam, Mahmoud Azhary, and Mohamed Hassan Ali supervised the study and contributed to data interpretation. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank all participants who took part in this study. References Obesity and overweight. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight . Accessed February 2, 2023. Chaudhuri GRC, Das A, Kesh SB, Bhattacharya K, Dutta S, Sengupta P, Syamal AK. Obesity and male infertility: multifaceted reproductive disruption. Middle East Fertil Soc J. 2022;27(8):1–12. 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Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13:37. Katib A. Mechanisms linking obesity to male infertility. Cent Eur J Urol. 2015;68(1):79. Sengupta P. Reviewing reports of semen volume and male aging of last 33 years: from 1980 through 2013. Asian Pac J Reprod. 2015;4(3):242–6. Sengupta P, Dutta S, Krajewska-Kulak E. The disappearing sperms: analysis of reports published between 1980 and 2015. Am J Mens Health. 2017;11(5):1279–304. Sengupta P, Borges E Jr, Dutta S, Krajewska-Kulak E. Decline in sperm count in European men during the past 50 years. Hum Exp Toxicol. 2018;37(3):247–55. Sengupta P, Nwagha U, Dutta S, Krajewska-Kulak E, Izuka E. Evidence for decreasing sperm count in African population from 1965 to 2015. Afr Health Sci. 2017;17(2):418–27. Sengupta P, Dutta S, Tusimin MB, İrez T, Krajewska-Kulak E. Sperm counts in Asian men: reviewing the trend of past 50 years. Asian Pac J Reprod. 2018;7(2):87–92. Sermondade N, Massin N, Boitrelle F, et al. Sperm parameters and male fertility after bariatric surgery: three case series. Obes Surg. 2014;24(2):206–10. Tables Table 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Table3.docx Table4.docx Table5.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 29 Jan, 2026 Reviews received at journal 26 Jan, 2026 Reviews received at journal 22 Jan, 2026 Reviewers agreed at journal 21 Jan, 2026 Reviewers agreed at journal 21 Jan, 2026 Reviewers invited by journal 21 Jan, 2026 Editor invited by journal 21 Jan, 2026 Editor assigned by journal 22 Dec, 2025 Submission checks completed at journal 21 Dec, 2025 First submitted to journal 21 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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00:04:45","extension":"tif","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2450772,"visible":true,"origin":"","legend":"","description":"","filename":"Figure1.tif","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/d1cdfcd725e2a3b07363bcfe.tif"},{"id":101206663,"identity":"4e2b2ccd-7f17-45fa-9b1a-4878e485b6ac","added_by":"auto","created_at":"2026-01-27 09:56:36","extension":"tif","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2338150,"visible":true,"origin":"","legend":"","description":"","filename":"Figure2.tif","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/e6e550b3486f57afb2ec0a59.tif"},{"id":101170711,"identity":"cb69fe06-5661-462e-9446-f3b13918a4ed","added_by":"auto","created_at":"2026-01-27 00:04:44","extension":"tif","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2314006,"visible":true,"origin":"","legend":"","description":"","filename":"Figure3.tif","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/50abd437f34083a4790a7bc1.tif"},{"id":101205975,"identity":"23f8ad91-f423-474c-ae38-8496e36a1fe5","added_by":"auto","created_at":"2026-01-27 09:50:48","extension":"xml","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":175461,"visible":true,"origin":"","legend":"","description":"","filename":"419222a3f61a4ad09abe8400ae203f791structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/c23f9fbf1b18eca51ce70875.xml"},{"id":101170717,"identity":"d25d5edd-eaba-446b-8e34-fb6adfb13e8e","added_by":"auto","created_at":"2026-01-27 00:04:44","extension":"html","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":210663,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/f662ed1421c5e26e1886a2fb.html"},{"id":101170704,"identity":"a49909c6-a481-454e-a43c-d5e67d32c0d1","added_by":"auto","created_at":"2026-01-27 00:04:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":5453,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant Flow Diagram.\u003c/p\u003e","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/03fe47855cf59aa421ad5627.png"},{"id":101170701,"identity":"24215747-79fe-4a0c-91be-cb8e8b8d2cf8","added_by":"auto","created_at":"2026-01-27 00:04:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17305,"visible":true,"origin":"","legend":"\u003cp\u003ea) Data were expressed as percent\u003c/p\u003e\n\u003cp\u003eb) \u003cstrong\u003eParameters\u003c/strong\u003e: \u0026nbsp;\u0026nbsp; Motility (%)  Progressive Motility (%)\u003c/p\u003e\n\u003cp\u003e Vitality (%)\u003cstrong\u003e \u003c/strong\u003e Abnormal Forms (%)\u003c/p\u003e\n\u003cp\u003ec) Mean percentages of total motility, progressive motility, vitality, and abnormal forms in semen analysis before surgery and at 3, 6, and 12 months postoperatively. Motility and vitality increased significantly over time (p \u0026lt; 0.001), with progressive motility improving steadily. A modest improvement in abnormal forms was observed.\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/bf32da582fccac01e2af6df7.png"},{"id":101170709,"identity":"d87287cd-1e9f-410b-926d-15e6cdc37170","added_by":"auto","created_at":"2026-01-27 00:04:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":17836,"visible":true,"origin":"","legend":"\u003cp\u003ea) Data were expressed as percent\u003c/p\u003e\n\u003cp\u003eb) Mean serum levels of testosterone (T), estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) at baseline and at 3, 6, and 12 months post-bariatric surgery among infertile obese male patients (n=43). Testosterone levels increased progressively, while estradiol levels declined significantly over time (p \u0026lt; 0.001). FSH, LH, and PRL exhibited slight nonsignificant reductions.\u003c/p\u003e\n\u003cp\u003ec) Purpose: Highlight significant improvements in semen quality over the 12-month follow-up.\u003c/p\u003e","description":"","filename":"OnlineFigure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/eafc83c8211658714892f2b0.png"},{"id":101208668,"identity":"d1a65f3c-dc6c-484f-92aa-9976310af009","added_by":"auto","created_at":"2026-01-27 10:10:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":687335,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/d4c3461b-8b68-4822-b741-5e79752bb06b.pdf"},{"id":101170702,"identity":"6644b126-30d2-4c3d-a227-be475007b413","added_by":"auto","created_at":"2026-01-27 00:04:44","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":13167,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/4a6afb4c3a557cc79842dc2b.docx"},{"id":101207120,"identity":"bb7a9941-9061-4fb5-aebc-162492926728","added_by":"auto","created_at":"2026-01-27 09:57:34","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":14507,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/99e5d953106f3a90cdadeab7.docx"},{"id":101206408,"identity":"e4717579-9f1a-46cf-b8d8-da44cad0dd98","added_by":"auto","created_at":"2026-01-27 09:56:11","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":19761,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/974c4c4d31232f8ddb309730.docx"},{"id":101170707,"identity":"ad82eea5-e575-4c32-895c-3a13b7b9a5bd","added_by":"auto","created_at":"2026-01-27 00:04:44","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":29058,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/7a59ef53d15befaa91bf4221.docx"},{"id":101170708,"identity":"33152fe9-2849-430f-bfba-7783fdf60d71","added_by":"auto","created_at":"2026-01-27 00:04:44","extension":"docx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":14275,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.docx","url":"https://assets-eu.researchsquare.com/files/rs-8293620/v1/8c7082975e35dc6239a7b4fe.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The influence of different bariatric surgeries on male sex hormones and parameters among infertile men with obesity","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eObesity affects over 650\u0026nbsp;million adults worldwide and is recognized as a modifiable risk factor for male infertility [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Excess adiposity promotes aromatization of testosterone to estradiol, leading to hypogonadotropic hypogonadism and impaired spermatogenesis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Large cohort studies have shown a dose-dependent relationship between body mass index (BMI) and sperm DNA fragmentation, although findings on conventional semen parameters remain inconsistent [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Lifestyle modification offers modest improvements, whereas metabolic and bariatric surgery (MBS) achieves sustained weight loss and may reverse obesity-related reproductive dysfunction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExcess adiposity impairs spermatogenesis through hormonal dysregulation, systemic inflammation, and oxidative stress [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Yet, associations between BMI and semen parameters remain heterogeneous, reflecting the multifactorial nature of obesity-related infertility [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. While lifestyle interventions provide limited benefit, MBS represents a more effective and durable option [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMultiple bariatric procedures have been developed, including Roux-en-Y gastric bypass, adjustable gastric banding, biliopancreatic diversion with duodenal switch, and sleeve gastrectomy. Patient selection criteria were established by the National Institutes of Health (NIH) in 1991 and remain the standard, typically applied to individuals aged 18\u0026ndash;60 years who commit to long-term follow-up [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Bariatric surgery promotes weight loss through restriction of intake and/or malabsorption [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eObesity contributes to multiple comorbidities, including infertility [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In women, hormonal imbalances and menstrual irregularities are key factors, while in men, impaired sperm quality and hormonal disturbances predominate. Non-surgical weight loss can improve reproductive parameters, but MBS is more effective, particularly in those with severe obesity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study evaluates the effects of MBS on serum sex hormone levels and semen parameters in infertile men with obesity\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design and Setting\u003c/h2\u003e \u003cp\u003eThis was a single-center, prospective observational case series of 43 men with obesity, conducted at a tertiary university hospital between January 2020 and December 2023. Patients were not randomized but underwent metabolic and bariatric surgery (MBS) according to clinical indications and surgeon preference. To reduce confounding across procedures\u0026mdash;sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and Roux-en-Y gastric bypass (RYGB)\u0026mdash;patients were matched post hoc for age (\u0026plusmn;\u0026thinsp;3 years), baseline body mass index (BMI; \u0026plusmn;2 kg/m\u0026sup2;), and type of infertility (primary vs. secondary).\u003c/p\u003e \u003cp\u003eThe primary outcome was change in semen parameters (motility, vitality, concentration, morphology) and serum sex hormones (total testosterone, follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol [E2], prolactin) at 3, 6, and 12 months post-surgery. Secondary outcomes included BMI and metabolic markers. The study followed the STROCSS 2021 guidelines [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Randomization was not feasible due to clinical heterogeneity; however, baseline characteristics were balanced across subgroups [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participant Characteristics\u003c/h2\u003e \u003cp\u003eOf 68 eligible men, 43 met inclusion criteria and consented to participate (rate: 63.2%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Inclusion criteria: men with obesity aged 16\u0026ndash;65 years, with primary or secondary infertility, surgically fit, and committed to long-term follow-up.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eExclusion criteria: prior abdominal/pelvic surgery, radiotherapy or chemotherapy, leukocytospermia, uncontrolled medical conditions, heavy smoking, clinical or subclinical varicocele, testicular atrophy (\u0026lt;\u0026thinsp;12 mL), structural genital pathology, psychological/sexual dysfunction, sleep disorders, or female-factor infertility. Varicocele was defined clinically or by Doppler ultrasound [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Reasons for exclusion were female-factor infertility (n\u0026thinsp;=\u0026thinsp;12), varicocele (n\u0026thinsp;=\u0026thinsp;6), prior surgery (n\u0026thinsp;=\u0026thinsp;4), and uncontrolled comorbidities (n\u0026thinsp;=\u0026thinsp;3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Intervention\u003c/h2\u003e \u003cp\u003ePreoperative evaluation: Included medical history, demographics, comorbidities, and investigations. Written informed consent was obtained.\u003c/p\u003e \u003cp\u003eLaboratory and imaging: Standard labs (CBC, FBS, HbA1c, liver and renal profile, coagulation tests), abdominal ultrasound, chest X-ray, and ECG.\u003c/p\u003e \u003cp\u003eSemen analysis: Collected after 2\u0026ndash;7 days abstinence, with two samples averaged. Processing followed WHO 6th edition [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Motility, morphology (Tygerberg criteria, \u0026lt;\u0026thinsp;4% normal forms abnormal), and vitality (eosin-nigrosin stain) were assessed. All analyses were performed by one blinded embryologist.\u003c/p\u003e \u003cp\u003eHormone profile: FSH, LH, testosterone, prolactin, and estradiol were measured by chemiluminescent immunoassay (Cobas e601, Roche Diagnostics). Inter-assay CV\u0026thinsp;\u0026lt;\u0026thinsp;8%. SHBG was measured; free testosterone calculated using the Vermeulen equation.\u003c/p\u003e \u003cp\u003eScrotal ultrasound: Evaluated testicular volume and pathology. Only men with normal architecture and bilaterally measurable testes were included.\u003c/p\u003e \u003cp\u003eSurgical procedures: All laparoscopic under general anesthesia.\u003c/p\u003e \u003cp\u003eSG: 36 Fr bougie, 4 cm proximal to pylorus.\u003c/p\u003e \u003cp\u003eOAGB: 200 cm biliopancreatic limb, 300 cm common channel.\u003c/p\u003e \u003cp\u003eRYGB: 75 cm biliopancreatic limb, 100 cm alimentary limb.\u003c/p\u003e \u003cp\u003ePostoperative care: Early mobilization, PPIs for 6\u0026ndash;8 weeks, gradual diet progression (liquid \u0026rarr; soft \u0026rarr; regular). Standard multivitamin supplementation included Centrum Silver\u0026reg;, vitamin D, calcium carbonate, B-complex, and whey protein. Antioxidants and fertility supplements were prohibited unless medically indicated.\u003c/p\u003e \u003cp\u003eFollow-up: At 3, 6, and 12 months, patients underwent physical exam, semen analysis, and hormone testing. Primary measures: semen quality and hormonal profile. Secondary: BMI.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e \u003cp\u003eChanges in semen and hormones were analyzed with linear mixed-effects models including fixed effects (time, age, baseline BMI, procedure) and random intercepts. Bonferroni correction was applied. Effect sizes reported with 95% confidence intervals. Sensitivity analyses excluded three patients with transient semen deterioration. Analyses were performed with SPSS v28 and R v4.3.1.\u003c/p\u003e \u003cp\u003eSample size: No a priori calculation; exploratory design. With 43 participants and expected effect size (Cohen\u0026rsquo;s d\u0026thinsp;\u0026ge;\u0026thinsp;0.6), the study achieved\u0026thinsp;\u0026gt;\u0026thinsp;80% power for testosterone changes at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Ethical Considerations\u003c/h2\u003e \u003cp\u003e The protocol was approved by the institutional research ethics committee (MD-296-2021). Written informed consent was obtained. Data confidentiality was maintained in accordance with the Declaration\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe majority of participants had primary infertility (65.1%), while 34.9% had secondary infertility. Most underwent sleeve gastrectomy (65.1%), with smaller groups receiving OAGB (16.3%) or RYGB (18.6%) (\u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMean BMI decreased significantly from 59.9 kg/m\u0026sup2; preoperatively to 30.4 kg/m\u0026sup2; at 12 months post-surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (\u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eSemen parameters improved significantly in motility, vitality, and progressive motility (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while sperm concentration showed no significant change (p\u0026thinsp;=\u0026thinsp;0.991) (\u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Three patients (7.0%) experienced transient declines in semen quality between 6 and 9 months, including one with severe oligoasthenoteratozoospermia. None developed azoospermia. Borderline deficiencies in zinc (n\u0026thinsp;=\u0026thinsp;2) and selenium (n\u0026thinsp;=\u0026thinsp;1) were corrected, and semen parameters stabilized or improved by 12 months.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSerum total testosterone increased significantly, while estradiol declined markedly (both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant changes were observed in FSH, LH, or prolactin (\u003cb\u003eTable\u0026nbsp;4\u003c/b\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical Relevance\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study evaluated infertile men with obesity and no prior bariatric surgery. A mean BMI reduction of nearly 30 kg/m\u0026sup2; was achieved within 12 months, moving participants from severe obesity to overweight or moderate obesity. This reduction lessens obesity-related health risks, including impaired fertility.\u003c/p\u003e \u003cp\u003eMBS improved semen quality\u0026mdash;particularly motility and vitality\u0026mdash;and produced favorable hormonal changes, with higher testosterone and lower estradiol. Sperm concentration remained stable, though abnormal forms decreased slightly, suggesting potential morphological recovery. Improvements may result from reduced oxidative stress and restored androgen\u0026ndash;estrogen balance.\u003c/p\u003e \u003cp\u003eGonadotropins (FSH, LH) showed minimal nonsignificant changes, suggesting that improvements were not primarily mediated by hypothalamic-pituitary regulation. Stable prolactin levels further support this. The significant reduction in estradiol appears central to restoring hormonal equilibrium and enhancing fertility potential.\u003c/p\u003e \u003cp\u003eCollectively, these findings indicate that MBS positively influences reproductive physiology in men with obesity by improving functional sperm quality and endocrine profiles (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis prospective study demonstrates that metabolic and bariatric surgery (MBS) is associated with significant improvements in reproductive hormones and semen quality among men with obesity and infertility. Notably, sperm motility, progressive motility, and vitality improved alongside higher testosterone and reduced estradiol. These findings are consistent with prior studies by El Bardisi et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Wood et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], although sperm concentration did not significantly change in our cohort. This suggests that functional aspects of sperm quality may be more responsive to hormonal and metabolic recovery than sperm quantity.\u003c/p\u003e \u003cp\u003eWhen comparing procedures, participants who underwent one-anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) experienced greater reductions in estradiol and more pronounced improvements in motility compared with those who underwent sleeve gastrectomy (SG). These findings may reflect the additional metabolic effects of intestinal rerouting and highlight the potential reproductive advantages of bypass procedures.\u003c/p\u003e \u003cp\u003eOur results differ from a previously reported case series in which some men experienced deterioration in semen quality following surgery [32]. In contrast, semen parameters in our cohort improved progressively over 12 months, with only transient declines observed in a minority of participants. These short-term changes underscore the importance of postoperative nutritional monitoring, as rapid weight loss and malabsorption can contribute to micronutrient deficiencies (e.g., zinc, selenium, folate) or toxin release, which may adversely affect spermatogenesis despite improved endocrine profiles.\u003c/p\u003e \u003cp\u003eThe strengths of this study include its prospective design, direct comparison of three commonly performed procedures, and exclusive focus on men with infertility\u0026mdash;a group underrepresented in previous research. Limitations include the absence of a non-surgical control group and reliance on semen analysis rather than clinical fertility outcomes.\u003c/p\u003e \u003cp\u003eFuture research should incorporate randomized controlled trials comparing MBS with lifestyle-based interventions and should evaluate pregnancy and live birth outcomes.\u003c/p\u003e \u003cp\u003eIn conclusion, MBS improves sperm motility, vitality, and hormonal balance in men with obesity and infertility, though sperm concentration appears largely unchanged. These findings support bariatric surgery as a potential strategy to improve male reproductive health, while emphasizing the need for ongoing nutritional surveillance and further investigation into long-term fertility outcomes\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eMetabolic and bariatric surgery (MBS) is associated with significant improvements in sperm motility, vitality, and serum testosterone levels among men with obesity and infertility, while sperm concentration remains unchanged. These findings suggest that MBS enhances functional aspects of sperm quality and restores hormonal balance, potentially improving fertility potential. However, the absence of pregnancy and live birth outcomes limits definitive conclusions regarding fertility restoration. MBS should therefore be considered as one component of a comprehensive management strategy for men with obesity-related infertility, with further investigation needed to clarify its long-term reproductive impact.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, it was a single-center prospective case series without a control group, which restricts causal interpretation. Second, the sample size was modest, particularly for subgroup analyses. Third, advanced assessments of sperm function\u0026mdash;such as DNA fragmentation, oxidative stress markers, and epigenetic parameters\u0026mdash;were not performed, despite their relevance to reproductive outcomes. Fourth, although abstinence periods and seasonal variation were standardized, residual variability may have influenced semen parameters. Fifth, while participants received standardized postoperative care, unmeasured lifestyle changes could have contributed to observed improvements. Sixth, fertility outcomes\u0026mdash;including pregnancy and live birth\u0026mdash;were not evaluated. Finally, although participants were advised to avoid fertility-enhancing supplements, minor unreported use cannot be fully excluded, though it was unlikely to alter group-level results.\u003c/p\u003e \u003cp\u003eFuture multicenter randomized controlled trials with larger cohorts, longer follow-up, and incorporation of advanced sperm function testing are needed to better define the role of MBS in male reproductive health.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eMBS:\u003c/strong\u003e Metabolic and bariatric surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNADPH;\u003c/strong\u003e Nicotinamide Adenine Dinucleotide Phosphate enzyme.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSHBG;\u003c/strong\u003e Sex hormone-binding globulin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTT;\u003c/strong\u003e Total testeron.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFT;\u003c/strong\u003e Free testeron.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePPIs;\u003c/strong\u003e Proton pump inhibitors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAZF;\u003c/strong\u003e Azoospermia Factor\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRYGB;\u003c/strong\u003e A Roux-en-Y gastric bypass.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSG;\u0026nbsp;\u003c/strong\u003eSleeve gastrectomy (SG).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOAGB;\u003c/strong\u003e One anastomosis gastric bypass.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVSG;\u003c/strong\u003e Vertical Sleeve Gastrectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICSI:\u003c/strong\u003e Intra-cytoplasmic sperm injection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOAT:\u003c/strong\u003e Oligoasthenoteratozoospermia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the \u003cstrong\u003eResearch Ethics Committee, Faculty of Medicine, Cairo University (Kasr Al-Ainy)\u003c/strong\u003e (Approval number:\u0026nbsp;\u003cstrong\u003eMD-296-2021\u003c/strong\u003e).\u003cbr\u003e\u0026nbsp;Written informed consent was obtained from all participants prior to enrollment.\u003cbr\u003eAll procedures performed in this study were conducted in accordance with the ethical standards of the institutional research committee and with the \u003cstrong\u003eDeclaration of Helsinki\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Due to privacy and ethical restrictions, the data are not publicly available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMahmoud Azhary and Ehab Fathy conceived the study and collected data.\u003cbr\u003e\u0026nbsp;Mahmoud Azhary and Mohamed Elshal developed the methodology.\u003cbr\u003e\u0026nbsp;Ahmed Tarek Mohamed and Ahmed Maher Abdelmonim contributed to writing, editing, and software analysis.\u003cbr\u003e\u0026nbsp;Ahmed Mohamed Salah Eldeen Othman Elansary contributed to review and funding support.\u003cbr\u003e\u0026nbsp;Mohamed Ahmed Abdelsalam, Mahmoud Azhary, and Mohamed Hassan Ali supervised the study and contributed to data interpretation.\u003cbr\u003e\u0026nbsp;All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participants who took part in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eObesity and overweight. World Health Organization. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed February 2, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaudhuri GRC, Das A, Kesh SB, Bhattacharya K, Dutta S, Sengupta P, Syamal AK. Obesity and male infertility: multifaceted reproductive disruption. Middle East Fertil Soc J. 2022;27(8):1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHammoud AO, Gibson M, Meikle AW, Carrell DT. Impact of obesity on male fertility: a review of clinical and molecular aspects. J Androl. 2022;43(2):123\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSermondade N, Faure C, Fezeu L, et al. 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Low estradiol concentrations in men with subnormal testosterone concentrations and type 2 diabetes. Diabetes Care. 2011;34(8):1854\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSermondade N, Massin N, Boitrelle F, et al. Sperm parameters and male fertility after bariatric surgery: three case series. Obes Surg. 2014;24(2):206\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWood GJA, Tiseo BC, Paluello DV, et al. bariatric surgery impact on reproductive hormones, semen analysis, and sperm DNA fragmentation in men with severe obesity: prospective study. Obes Surg. 2020;30(12):4840\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLegro RS, Dodson WC, Gnatuk CL, Effects of gastric bypass surgery on female reproductive function. J Clin Endocrinol Metab., Kj\u0026aelig;r MM, Madsbad S, Hougaard DM, Cohen AS, Nilas L et al. The impact of gastric bypass surgery on sex hormones and menstrual cycles in premenopausal women. Gynecol Endocrinol. 2017; 33(2):160\u0026ndash;163.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAarts MA et al. Gonadal status and outcome of bariatric surgery in men with obesity. Clin Endocrinol (Oxf). 2014. Accessed February 2, 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHammoud AO, Meikle AW, Reis LO, Gibson M, Peterson CM, Carrell DT. Obesity and male infertility: a practical approach. Semin Reprod Med., Leisegang K, Dutta S. Do lifestyle practices impede male fertility? Andrologia. 2021;53(2):e13595.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Institutes of Health Consensus Conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991; 115(12):956\u0026ndash;961.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBest D, Bhattacharya S. Obesity and fertility. Horm Mol Biol Clin Investig. 2015;24(1):510.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang C, Chang S, Poles J, Popov V. The impact of bariatric surgery compared to metformin therapy on pregnancy outcomes in patients with polycystic ovarian syndrome: a systematic review and meta-analysis. J Gastrointest Surg., Best D, Avenell A, Bhattacharya S. How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence. Hum Reprod Update. 2017;23(6):681\u0026ndash;705.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgha RA, Sohrabi C, Franchi T, et al. The STROCSS statement: strengthening the reporting of cohort studies in surgery. Int J Surg. 2021;87:161\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWood GJA, Hinds A, Bewick MA, et al. Male fertility following bariatric surgery: a cohort study. Obes Surg. 2020;30(9):3456\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSermondade N, Panner Selvam MK, Twigg MJ, et al. Paternal obesity and assisted reproductive technology outcomes: an overview of systematic reviews. Obes Surg. 2014;24(12):2139\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJung A, Schuppe HC. Male infertility: diagnosis and management of varicocele. Dtsch Arztebl Int. 2007;104(25):A1586\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. WHO laboratory manual for the examination and processing of human semen. 6th ed. Geneva: World Health Organization; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl 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\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Salam MAA. Obesity, an enemy of male fertility: a mini review. Oman Med J. 2018;33(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13:37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatib A. Mechanisms linking obesity to male infertility. Cent Eur J Urol. 2015;68(1):79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSengupta P. Reviewing reports of semen volume and male aging of last 33 years: from 1980 through 2013. Asian Pac J Reprod. 2015;4(3):242\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSengupta P, Dutta S, Krajewska-Kulak E. The disappearing sperms: analysis of reports published between 1980 and 2015. Am J Mens Health. 2017;11(5):1279\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSengupta P, Borges E Jr, Dutta S, Krajewska-Kulak E. Decline in sperm count in European men during the past 50 years. Hum Exp Toxicol. 2018;37(3):247\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSengupta P, Nwagha U, Dutta S, Krajewska-Kulak E, Izuka E. Evidence for decreasing sperm count in African population from 1965 to 2015. Afr Health Sci. 2017;17(2):418\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSengupta P, Dutta S, Tusimin MB, İrez T, Krajewska-Kulak E. Sperm counts in Asian men: reviewing the trend of past 50 years. Asian Pac J Reprod. 2018;7(2):87\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSermondade N, Massin N, Boitrelle F, et al. Sperm parameters and male fertility after bariatric surgery: three case series. Obes Surg. 2014;24(2):206\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Obesity, metabolic and bariatric surgery (MBS), one-anastomosis gastric bypass (OAGB), Roux-en-Y gastric bypass (RYGB)","lastPublishedDoi":"10.21203/rs.3.rs-8293620/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8293620/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eObesity negatively impacts male fertility through hormonal disturbances and deteriorated semen parameters. Metabolic and bariatric surgery (MBS) offers sustained weight loss and potential reversal of these abnormalities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis prospective case series included 43 with severe obesity infertile men who underwent sleeve gastrectomy, One-anastomosis gastric bypass (OAGB), or Roux-en-Y gastric bypass. All participants had a BMI\u0026thinsp;\u0026ge;\u0026thinsp;35 kg/m\u0026sup2; and a history of infertility for over one year. Semen analysis and hormonal profiling (FSH, LH, total testosterone, estradiol [E2], and prolactin) were conducted preoperatively and at 3, 6, and 12 months postoperatively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSignificant weight loss was observed at all follow-up points (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Improvements were noted in semen motility, progressive motility, vitality, and abnormal forms (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Serum testosterone levels increased, while estradiol levels decreased significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Changes in FSH, LH, and prolactin were statistically insignificant.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMetabolic and bariatric surgery (MBS) is associated with marked improvements in semen quality and serum testosterone levels, supporting its role as an effective therapeutic strategy for obesity-related male infertility.\u003c/p\u003e","manuscriptTitle":"The influence of different bariatric surgeries on male sex hormones and parameters among infertile men with obesity","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-27 00:04:39","doi":"10.21203/rs.3.rs-8293620/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-29T09:44:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-26T19:34:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-23T02:15:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21874021218508677425660657466130628829","date":"2026-01-22T04:32:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"143461829511267104011847955685858173514","date":"2026-01-22T00:22:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-21T20:08:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-21T13:50:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-22T10:58:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-21T11:28:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-12-21T11:21:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"749a0f05-5859-443c-9e01-7e0a87db0d98","owner":[],"postedDate":"January 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-27T13:29:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-27 00:04:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8293620","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8293620","identity":"rs-8293620","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}