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Infertility and Sexual Dysfunction

February 9, 2021

Infertility and Sexual Dysfunction: Association with Obesity

Obesity is a growing epidemic that increases the risk of heart disease, diabetes, and other chronic health issues. In addition to this, obesity has a detrimental influence on the reproductive system. According to the American Society for Reproductive Medicine (ASRM), obesity is the main cause of fertility problems in six percent of women who have never been pregnant.
The relationship between sexual functioning and obesity is highly complex. Obesity affects your fertility as well as your partner’s in different ways. Research shows that obese individuals have 25 times more chance of having sex-related problems when compared to people with normal BMI. Obese women may have hormonal imbalances, which can reduce their ability to ovulate normally, whereas obese men may experience erectile dysfunction, hormonal disturbances and lower semen quality, all contributing to infertility.

Obesity and infertility

Infertility is defined as the inability to become pregnant despite having frequent, unprotected sex for at least a year. It can affect men and women equally. Obesity also increases the risk of miscarriage, and decreases the rate of successful pregnancy through natural conception.

Being overweight or obese can alter ones’ fertility via several biochemical mechanisms:

  • Increased hormone production contributed by adipose tissue with respect to either endogenous or exogenous steroidal hormones lead to altered hormone levels.
  • Changes in metabolism and excretion of hormones or altered production of steroids hormone binding proteins, e.g., sex hormone binding globulin (SHBG) can mess with sperm count, concentration and motility.

Obesity and infertility in men: Obesity is a common problem among men in the reproductive age, and can cause and exacerbate male-factor infertility. The major risk factors of male infertility include age, infectious diseases, environmental factors, obesity and its related disorders.

According to many studies, obesity in males may cause alterations in the sperm parameters like sperm count, total motility, structure and sperm DNA. Obesity exacerbates male-factor infertility by causing endocrine abnormalities and can have direct effects on spermatogenesis (origin and development of sperm cells). Obese men exhibit reduced androgen and sex hormone binding globulin (SHBG) levels accompanied by elevated estrogen levels. This altered reproductive hormonal profile leads to altered semen parameters, low testicular volume, and impaired sperm production. Low testosterone levels can affect the sperm’s ability to penetrate the egg, thus reducing the chances of fertilization.

Obesity and infertility in women: Infertility in obese women is mainly due to hyperinsulinemia (high insulin level in blood) and hyperandrogenemia (abnormally high levels of androgen).

Insulin plays an important role in the regulation of sex hormones. Hyperinsulinemia can contribute to increased androgen secretion and abnormal follicles in the ovaries.

Additionally, obese women have slightly high thyroid stimulating hormone (TSH) and prolactin levels. Prolactin acts by altering the ratio of follicle stimulating hormone (FSH) and luteinizing hormone, thereby inhibiting ovulation. Elevated TSH level can lead to hypothyroidism which in turn decreases the level of sex hormone binding globulin (SHBG) and elevates the androgen levels in women.

Obesity and sexual dysfunction

Sexual dysfunction is characterized by persistent difficulty with sexual response, desire, orgasm or sexual pain in men and women. It can affect anyone at any time, but is common in couples struggling with infertility. Sexual dysfunction might be a reason for infertility or may be triggered by infertility. The most frequent sexual dysfunction among men is erectile dysfunction (ED) and hypoactive sexual desire disorder (HSDD) in women.

Though sexual dysfunction can be caused by physical and psychological factors, obesity plays a major role in sexual performance.

Obesity and male sexual dysfunction:

In obese men, infertility can underlie sexual dysfunction which is often characterized by erectile dysfunction (ED). Erectile dysfunction refers to the consistent inability to achieve or maintain a penile erection during sexual intercourse. It usually occurs when there is a restricted flow of blood in the penis.
In obese men, excess cholesterol in the blood may get deposited on the inner walls of the blood vessels. These atherosclerotic deposits in the penis blood vessels can reduce the blood flow to the penis, leading to erectile dysfunction.

Obesity and female sexual dysfunction:

Female sexual dysfunction is a complex condition that is associated with numerous anatomical, physiological and psychological factors. Research shows that obesity is associated with specific sexual dysfunctions in women.
Obesity-associated insulin resistance can alter the functioning of the hypothalamus and the pituitary gland in the brain, increasing the production of androgenic hormones in women. Excessive production of androgenic hormones and reduced production of estrogen leads to female infertility which is responsible for female sexual dysfunction.

Treatment for obesity related sexual dysfunction and infertility

Sexual dysfunction in a couple with infertility is a complex issue that needs appropriate treatment and care. Keeping the BMI in the healthy range is the key for management of obesity related infertility and sexual dysfunction. The couple must work towards changing the lifestyle. Lifestyle modification involves altering the long-term habits, typically the eating habits or physical activity, and maintaining the new behavior lifelong. Infertility management also involves appropriate medical therapy and addressing the psycho-social concerns of the couple.

References :

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  8. Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion. https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non members/diagnostic_evaluation_of_sexual_dysfunction_in_the_male_partner.pdf . Accessed on: 03-08-2020
  9. Skrypnik D, Bogdański P, Musialik K. Otyłość–istotny czynnik ryzyka zaburzeń potencji u mezczyzn [Obesity–significant risk factor for erectile dysfunction in men]. Pol Merkur Lekarski. 2014;36(212):137-141.
  10. Mozafari M, Khajavikhan J, Jaafarpour M, Khani A, Direkvand-Moghadam A, Najafi F. Association of body weight and female sexual dysfunction: a case control study. Iran Red Crescent Med J. 2015;17(1):e24685. Published 2015 Jan 23.
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  12. Association Between Infertility and Sexual Dysfunction in Men and Women. https://www.smr.jsexmed.org/article/S2050-0521(16)30005-1/fulltext. Accessed on: 03-08-2020.

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