2020-06-07 Arnold Achermann, Androfert, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil, Brazil
This retrospective and single-center study aimed first to investigate the effect of body mass index (BMI) on sperm retrieval and to analyze the associations between BMI and levels of hormones to positivity of TESE outcomes as a secondary objective. The authors analyzed their database of infertile men with non-obstructive azoospermia who underwent TESE procedure. Although the authors found a negative association between BMI and serum testosterone (T) levels, they concluded that there is no influence of any class of obesity to TESE outcomes. On the other hand, several studies have confirmed that estradiol (E2) levels are significantly increased in overweight and obese patients by testosterone conversion to estradiol in adipose tissue. The high levels of E2 inhibit T biosynthesis and reduce the amplitude of cycle secretion of LH and FSH by hypophysis. The benefits of inhibitor aromatase usage are already known when the patient shows the relation between T and E2 lower than 10. The normalization of this relation can improve significantly, and it has been extensively proved and reported by several authors. Ramasamy et al. reported a retrospective study in which sperm retrieval rates were similar between patients with normal BMI and overweight when they underwent microdissection TESE [1]. However, the BMI showed a negative predictor of a successful pregnancy. This paper paves the way for future prospective studies that compare BMI with TESE outcomes and pregnancy rates.

1 - Ramasamy R, Bryson C, Reifsnyder JE, Neri Q, Palermo GD, Schlegel PN. Overweight men with nonobstructive azoospermia have worse pregnancy outcomes after microdissection testicular sperm extraction. Fertil Steril. 2013;99(2):372‐376. doi:10.1016/j.fertnstert.2012.10.025