PREVALENCE OF POOR SEMEN

PARAMETERS IN MEN WITH METABOLIC

SYNDROMEDr Sathya Balasubramanyam

MD,DNB,MRCOG,FNB(Reprod Med)

Senior Consultant, Institute of Reproductive Medicine and Women’s Health,

Madras Medical Mission, Chennai , India

BACKGROUND A declining trend in semen parameters

among fertile men in the last 20 years has been described.(Jouannet et al N Engl J Med Feb 1995)

Whether male infertility is actually increasing has still not been clearly established.

Lifestyle changes have been associated with male infertility- eg. smoking, sedentary lifestyle.

Recent population-based studies suggest an elevated risk for subfertility among couples in which the male partner is obese and an increased likelihood of abnormal semen parameters among heavier men.

Fertil Steril. Hammoud et.al Oct 2008.

METABOLIC SYNDROME The metabolic syndrome is a cluster of

the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure.

A quarter of the world’s adults have metabolic syndrome.

People with metabolic syndrome are twice as likely to die from, and three times as likely to have a heart attack or stroke compared with people without the syndrome.

People with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes.

This puts metabolic syndrome and diabetes way ahead of HIV/AIDS in morbidity and mortality terms yet the problem is not as well recognised.

STUDY DETAILS Aim: to assess the prevalence of

metabolic syndrome in men with normal and abnormal semen parameters.

Setting: Institute of Reproductive Medicine.

Materials and Methods: 748 men underwent semen analysis in the infertility clinic from Aug 2009 till March 2010.

We have complete data to diagnose Metabolic syndrome in 526 men.

The men were assessed for the following parameters to diagnose metabolic syndrome

Waist circumference, Blood Pressure, Fasting Blood Sugar, HDL and Triglycerides. All of them underwent a Semen

analysis in the same andrology lab.

NCEP ATPIII GUIDELINES

Waist circumference >102 cm Blood pressure >/= 130/85mmHg Fasting Blood Glucose >/=110mg/dl HDL < 40 mg/dl Triglycerides >150 mg/dl

WHO 2010 CRITERIA Sperm concentration, total motility and

morphology were assessed –

Concentration 15 million/ml Motility 40% Morphology 4%

RESULTS Mean age of men in our study was

34.3±3.4 years. Proportion of abnormal semen

parameters in men attending our infertility clinic was 241/526 (46%).

Number of men with metabolic syndrome was 136 (26.5 %).

Prevalence of Metabolic syndrome in men in Chennai 18%.

Sample size based on prevalence-248

Number of men with metabolic syndrome and normal sperm parameters-79/285(27.7%)

Number of men with metabolic syndrome and abnormal sperm parameters-57/241(23.2%)

Chi square test showed that the difference was not statistically significant P=0.16

Number of men with BMI>30 was 84/526(15.9%)

42/84 had abnormal semen parameters (50%).

Proportion of non obese men with abnormal semen parameters 199/442(45.02%)

Chi square test P=0.36

Number of men with BMI>35=13, all 13 had abnormal semen parameters.

WAIST CIRCUMFERENCE AND SPERM PARAMETERS

78/526 men had high abnormal waist circumference (15%). Population prevalence 20.8%.

46/241had waist >102cm and abnormal sperm parameters(19%).

32/285 had waist>102 cm and normal sperm parameters(11.2%).

P=0.15

FASTING BLOOD GLUCOSE AND SPERM PARAMETERS

82/526 men had high fasting blood sugars (15.6%). Population prevalence 18.2%.

36 men had high fasting sugars and abnormal sperm parameters (14.9%)

46 men had high fasting sugars and normal sperm parameters (16.1%)

P=0.74

SERUM TRIGLYCERIDE LEVELS AND SPERM PARAMETERS

249/526 men had abnormal triglyceride levels (47.3%). Population prevalence 32%.

105 men with high triglycerides had abnormal sperm parameters.

144 men with high triglycerides had normal sperm parameters.

P=0.272

SERUM HDL AND SPERM PARAMETERS 373/526 men had low HDL levels

(70.9%).Population prevalence is 54.9%.

176 men had low HDL levels and abnormal sperm parameters.

197 men had low HDL levels and normal sperm parameters.

P=0.46

BP AND SPERM PARAMETERS

138/526 men had BP>130/85(26.2%).Population prevalence 35%

71 men with high blood pressure had abnormal semen analysis 29.4%.

67 men had high blood pressure and normal sperm parameters 23.5%

P=0.27

DISCUSSION BMI was found to be unrelated to

sperm concentration, motility and morphology by Chavarro et al in their study on 483 male partners of subfertile couples.(May 2010 FertilSteril)

Jensen et al found no dose response relationship between BMI and sperm concentration in their study 1158 young Danish military recruits(Fertil Steril 2004; 82:863-70).

Magnusdottir et al found a statistically significant negative correlation between increasing BMI and sperm concentration in men with normal sperm concentration(Hum Reprod. 2005;20:208-15)

There are conflicting reports on the effect of BMI on sperm motility.

There is no evidence currently of an effect of increasing BMI and abnormal sperm morphology.(Hammoud et al FertilSteril Oct 2008)

We could not find any studies assessing the effect of metabolic syndrome on sperm parameters.( according to the latest WHO 2010 GUIDELINES).

In our study, 26% of men had metabolic syndrome was found to be higher than that in the general population 18%.

The prevalence of Metabolic syndrome was not significantly different in those with normal or abnormal semen parameters.

CONCLUSIONS

Metabolic syndrome by itself does not appear to increase the chances of a man having abnormal sperm parameters.

Unlike in women, metabolic syndrome does not appear to have a major effect on fertility at least in the early stages.

Longitudinal studies are needed to see if semen parameters tend to deteriorate over time in men with metabolic syndrome.

If not identified earlier on, morbid obesity could lead on to abnormalities in the semen analysis.

Population based studies would give a more accurate information on the effect of metabolic syndrome in men with respect to duration to conception.

THANK YOU