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

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.