OJEpi  Vol.5 No.3 , August 2015
Association of Obesity with Infertility among Pakistani Men: A Case Control Study
Abstract: Background: The reported prevalence of infertility in Pakistan is 21% of which 35% is contributed by male factor. Male infertility has multifactorial etiologies ranging from modifiable to genetic risk factors. Among all the risk factors that may account for male infertility, obesity is one of the emerging public health problems. Therefore, the aim of the study was to determine the association of obesity with infertility in Pakistani men. Methods: We conducted a case control study. Cases were men with impaired semen parameters and controls did not have impaired semen parameters. Results: The final multivariable logistic regression model after adjusting for the effect of other variables revealed that with every 1 kg/m2 increase in BMI the odds of being infertile was 6% higher as compared to being fertile (aOR = 1.06; 95% CI = 1.01, 1.11). Moreover the odds of having education of higher secondary or above was 3 times greater among cases as compared with the controls (OR = 3.10; 95% CI = 1.66, 5.77). Furthermore the odds of having previous medical conditions increasing the risk of infertility was higher among cases as compared with the controls (OR = 3.07; 95% CI = 1.63, 5.79). Conclusion & recommendations: This study indicates that obesity is an important risk factor for male infertility. Moreover our findings also indicate that higher educational status and previous medical conditions are also associated with male infertility. Thus awareness can be raised through treating physicians and public health messages.
Cite this paper: Zahid, N. , Saleem, S. , Azam, I. and Moatter, T. (2015) Association of Obesity with Infertility among Pakistani Men: A Case Control Study. Open Journal of Epidemiology, 5, 204-215. doi: 10.4236/ojepi.2015.53025.

[1]   Evens, E.M. (2004) A Global Perspective on Infertility: An Under Recognized Public Health Issue. Carolina Papers in International Health, No. 18. University Center North Carolina at Chapel Hill.

[2]   Sami, N. and Ali, T.S. (2006) Psycho-Social Consequences of Secondary Infertility in Karachi. Journal-Pakistan Me- dical Association, 56, 19.

[3]   Saeed, S., Khan, F.A., Rahman, S.B., Khan, D.A. and Ahmad, M. (1994) Biochemical Parameters in Evaluation of Oligospermia. The Journal of the Pakistan Medical Association, 44, 137.

[4]   Zakai, F., Uddin, S., Akram, M., Mohiuddin, E., Hannan, A. and Usmanghani, K. (2011) Introduction to Male Infertility. Journal of Medicinal Plants Research, 5, 5936-5945.

[5]   Wang, R. and Allison, J. (2005) Male Infertility. Science, 308, 1466-1469.

[6]   McLachlan, R.I. and Krausz, C. (2011) Clinical Evaluation of the Infertile Male: New Options, New Challenges. Asian Journal of Andrology, 14, 3-5.

[7]   Nanan, D.J. (2002) The Obesity Pandemic-Implications for Pakistan. The Journal of the Pakistan Medical Association, 52, 342-346.

[8]   Jafar, T.H., Chaturvedi, N. and Pappas, G. (2006) Prevalence of Overweight and Obesity and Their Association with Hypertension and Diabetes Mellitus in an Indo-Asian Population. Canadian Medical Association Journal, 175, 1071- 1077.

[9]   Ramachandran, A. and Snehalatha, C. (2010) Rising Burden of Obesity in Asia. Journal of Obesity, 2010, Article ID: 868573.

[10]   Dennis, B., Aziz, K., She, L., Faruqui, A.M., Davis, C.E., Manolio, T.A., Burke, G.L. and Aziz, S. (2006) High Rates of Obesity and Cardiovascular Disease Risk Factors in Lower Middle Class Community in Pakistan: The Metroville Health Study. Journal of Pakistan Medical Association, 56, 267-272.

[11]   Hammoud, A.O., Gibson, M., Peterson, C.M., Meikle, A.W. and Carrell, D.T. (2008) Impact of Male Obesity on Infertility: A Critical Review of the Current Literature. Fertility and Sterility, 90, 897-904.

[12]   Hammoud, A.O., Wilde, N., Gibson, M., Parks, A., Carrell, D.T. and Meikle, A.W. (2008) Male Obesity and Alteration in Sperm Parameters. Fertility and Sterility, 90, 2222-2225.

[13]   Ivell, R. (2007) Lifestyle Impact and the Biology of the Human Scrotum. Reproductive Biology and Endocrinology, 5, 15.

[14]   Shafik, A. and Olfat, S. (1981) Lipectomy in the Treatment of Scrotal Lipomatosis. British Journal of Urology, 53, 55- 61.

[15]   Sharpe, R.M. (2010) Environmental/Lifestyle Effects on Spermatogenesis. Philosophical Transactions of the Royal Society B: Biological Sciences, 365, 1697-1712.

[16]   Gill, T. (2006) Epidemiology and Health Impact of Obesity: An Asia Pacific Perspective. Asia Pacific Journal of Clinical Nutrition, 15, 3-14.

[17]   Chavarro, J.E., Toth, T.L., Wright, D.L., Meeker, J.D. and Hauser, R. (2010) Body Mass Index in Relation to Semen Quality, Sperm DNA Integrity, and Serum Reproductive Hormone Levels among Men Attending an Infertility Clinic. Fertility and Sterility, 93, 2222-2231.

[18]   De Fleurian, G., Perrin, J., Ecochard, R., Dantony, E., Lanteaume, A., Achard, V., Grillo, J.M., Guichaoua, M.R., Botta, A. and Sari-Minodier, I. (2009) Occupational Exposures Obtained by Questionnaire in Clinical Practice and Their Association with Semen Quality. Journal of Andrology, 30, 566-579.

[19]   He, J., Liu, H.C., Yu, W.Z. and Zou, H.Y. (2008) Semen Analysis of Sterile Patients among Occupational Computermen. National Journal of Andrology, 14, 914.

[20]   Cherry, N., Labreche, F., Collins, J. and Tulandi, T. (2001) Occupational Exposure to Solvents and Male Infertility. Occupational and Environmental Medicine, 58, 635-640.

[21]   Magnusdottir, E.V., Thorsteinsson, T., Thorsteinsdottir, S., Heimisdottir, M. and Olafsdottir, K. (2005) Persistent Organochlorines, Sedentary Occupation, Obesity and Human Male Subfertility. Human Reproduction, 20, 208-215.

[22]   Chia, S.-E. and Tay, S.-K. (2001) Occupational Risk for Male Infertility: A Case-Control Study of 218 Infertile and 227 Fertile Men. Journal of Occupational and Environmental Medicine, 43, 946-951.

[23]   Noruziyan, Z., Roghanian, R., Hosseinzadeh, S., Golbang, N. and Nasr Esfahani, M.H. (2012) Possible Role of Chlamydia trachomatis in the Male Partner of Infertile Couples. Comparative Clinical Pathology, 22, 421-424.

[24]   Akl, E.A., Gaddam, S., Gunukula, S.K., Honeine, R., Jaoude, P.A. and Irani, J. (2010) The Effects of Waterpipe Tobacco Smoking on Health Outcomes: A Systematic Review. International Journal of Epidemiology, 39, 834-857.

[25]   Greendale, G.A., Haas, S.T., Holbrook, K., Walsh, B., Schachter, J. and Phillips, R.S. (1993) The Relationship of Chlamydia trachomatis Infection and Male Infertility. American Journal of Public Health, 83, 996-1001.

[26]   Menkveld, R., Wong, W.Y., Lombard, C.J., Wetzels, A.M.M., Thomas, C.M.G., Merkus, H.M.W.M. and Steegers- Theunissen, R.G.P.M. (2001) Semen Parameters, Including WHO and Strict Criteria Morphology, in a Fertile and Subfertile Population: An Effort towards Standardization of In-Vivo Thresholds. Human Reproduction, 16, 1165-1171.

[27]   Agarwal, A. and Said, T.M. (2003) Role of Sperm Chromatin Abnormalities and DNA Damage in Male Infertility. Human Reproduction Update, 9, 331-345.

[28]   Rojas-MartÃnez, R., Aguilar-Salinas, C.A., Jiménez-Corona, A., Gómez-Pérez, F.J., Barquera, S.N. and Lazcano- Ponce, E. (2012) Prevalence of Obesity and Metabolic Syndrome Components in Mexican Adults without Type 2 Diabetes or Hypertension. Salud Pública de México, 54, 7-12.

[29]   Hofny, E.R.M., Ali, M.E., Abdel-Hafez, H.Z., Kamal, E.E.-D., Mohamed, E.E., Abd El-Azeem, H.G. and Mostafa, T. (2010) Semen Parameters and Hormonal Profile in Obese Fertile and Infertile Males. Fertility and Sterility, 94, 581-584.

[30]   James, P.T., Leach, R., Kalamara, E. and Shayeghi, M. (2001) The Worldwide Obesity Epidemic. Obesity Research, 9, 228S-233S.

[31]   Flegal, K.M., Shepherd, J.A., Looker, A.C., Graubard, B.I., Borrud, L.G., Ogden, C.L., Harris, T.B., Everhart, J.E. and Schenker, N. (2009) Comparisons of Percentage Body Fat, Body Mass Index, Waist Circumference, and Waist-Stature ratio in Adults. The American Journal of Clinical Nutrition, 89, 500-508.

[32]   Bujan, L., Daudin, M., Charlet, J.-P., Thonneau, P. and Mieusset, R. (2000) Increase in Scrotal Temperature in Car Drivers. Human Reproduction, 15, 1355-1357.

[33]   Akinloye, O. and Truter, E.J. (2011) A Review of Management of Infertility in Nigeria: Framing the Ethics of a National Health Policy. International Journal of Women’s Health, 3, 265-275.

[34]   MacDonald, A.A., Herbison, G.P., Showell, M. and Farquhar, C.M. (2010) The Impact of Body Mass Index on Semen Parameters and Reproductive Hormones in Human Males: A Systematic Review with Meta-Analysis. Human Reproduction Update, 16, 293-311.

[35]   Pasqualotto, F.F., Lucon, A.M., Sobreiro, B.P., Pasqualotto, E.B. and Arap, S. (2004) Effects of Medical Therapy, Alcohol, Smoking, and Endocrine Disruptors on Male Infertility. Revista do Hospital das Clínicas, 59, 375-382.

[36]   Ramalho-Santos, J., Amaral, S. and Oliveira, P.J. (2008) Diabetes and the Impairment of Reproductive Function: Po- ssible Role of Mitochondria and Reactive Oxygen Species. Current Diabetes Reviews, 4, 46-54.

[37]   Dohle, G.R., Colpi, G.M., Hargreave, T.B., Papp, G.K., Jungwirth, A. and Weidner, W. (2005) EAU Guidelines on Male Infertility. European Urology, 48, 703-711.

[38]   Schiff, J.D., RamÃ-rez, M.L. and Bar-Chama, N. (2007) Medical and Surgical Management Male Infertility. Endocrinology and Metabolism Clinics of North America, 36, 313-331.

[39]   Håkonsen, L.B., Thulstrup, A.M., Aggerholm, A.S.R., Olsen, J.R., Bonde, J.P., Andersen, C.Y., Bungum, M., Ernst, E.H., Hansen, M.L. and Ernst, E.H. (2011) Does Weight Loss Improve Semen Quality and Reproductive Hormones? Results from a Cohort of Severely Obese Men. Reproductive Health, 8, 24.

[40]   Abdalla, N.M. (2011) Epidemiology of Infertility in Gezira Region, Central of Sudan. Research Journal of Medical Sciences, 5, 56-60.

[41]   Gracia, C.R., Sammel, M.D., Coutifaris, C., Guzick, D.S. and Barnhart, K.T. (2005) Occupational Exposures and Male Infertility. American Journal of Epidemiology, 162, 729-733.

[42]   Jensen, T.K., Bonde, J.P. and Joffe, M. (2006) The Influence of Occupational Exposure on Male Reproductive Function. Occupational Medicine, 56, 544-553.

[43]   Sharpe, R.M. (2000) Lifestyle and Environmental Contribution to Male Infertility. British Medical Bulletin, 56, 630- 642.

[44]   Meeker, J.D., Rossano, M.G., Protas, B., Diamond, M.P., Puscheck, E., Daly, D., Paneth, N. and Wirth, J.J. (2008) Cadmium, Lead, and Other Metals in Relation to Semen Quality: Human Evidence for Molybdenum as a Male Reproductive Toxicant. Environmental Health Perspectives, 116, 1473-1479.

[45]   de la Calle, J.F.V., Rachou, E., le Martelot, M.-T.R.S., Ducot, B.A., Multigner, L. and Thonneau, P.F. (2001) Male Infertility Risk Factors in a French Military Population. Human Reproduction, 16, 481-486.

[46]   Ali, S., Sophie, R., Imam, A.M., Khan, F.I., Ali, S.F., Shaikh, A. and Farid-ul-Hasnain, S. (2011) Knowledge, Perceptions and Myths Regarding Infertility among Selected Adult Population in Pakistan: A Cross-Sectional Study. BMC Public Health, 11, 760.

[47]   Goossens, V., Bhattacharya, S., Ferraretti, A.P., Kupka, M.S., de Mouzon, J., Nygren, K.G., Glozheni, O., Candeur, M., Kyurkchiev, S. and Radakovic, B. (2009) Assisted Reproductive Technology and Intrauterine Inseminations in Europe, 2005: Results Generated from European Registers by ESHRE. ESHRE. The European IVF Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Human Reproduction, 24, 1267- 1287.

[48]   Aston, K.I. and Conrad, D.F. (2013) The Sperm Genome: Effect of Aneuploidies, Structural Variations, Single Nucleotide Changes, and DNA Damage on Embryogenesis. In: Carrell, D.T., Ed., Paternal Influences on Human Reproductive Success, Cambridge University Press, Cambridge, 6-15.