Overweight men with nonobstructive azoospermia have worse pregnancy outcomes after microdissection testicular sperm extraction

Overweight men have lower clinical pregnancy rate after microdissection testicular sperm extraction and intracytoplasmic sperm injection compared with men with normal weight. Men with body mass index >43 kg/m2 did not contribute to any pregnancies despite successful sperm retrieval.

Ranjith Ramasamy, M.D., Campbell Bryson, B.A., Jennifer E. Reifsnyder, M.D., Queenie Neri, M.S., Gianpiero D. Palermo, M.D., Peter N. Schlegel, M.D.

Volume 99, Issue 2, Pages 372-376, February 2013


To evaluate the effect of obesity on the outcome of testicular sperm extraction (TESE) and assisted reproductive technology.

Clinical retrospective study.

Center for reproductive medicine at a tertiary university hospital.

Nine hundred and seventy patients with non-obstructive azoospermia.

Microdissection testicular sperm extraction (TESE), followed by intracytoplasmic sperm injection (ICSI).

Main outcome measure(s):
Sperm retrieval rate and clinical pregnancy rate.

Testicular sperm were successfully retrieved in 55% of men overall. Of those with sperm found, clinical pregnancy rate was 51% and live birth rate was 40%. Sperm retrieval rates were similar in men with Body Mass Index < 25, 25-30, and > 30 (59%, 57%, and 54% respectively). Mean BMI of men who contributed to pregnancy (27.3 + 4.9 kg/m2) was lower (p=0.04) than for men whose sperm did not contribute to a pregnancy (28.2 + 5.4 kg/m2). No man with BMI > 43 (n=11) contributed to a successful pregnancy, even though sperm were found in men with BMI upto 57 kg/m2. On multivariable logistic regression analysis male BMI was the only predictor of successful pregnancy among the variables analyzed, including male age, female age and female BMI.

Overweight men have lower clinical pregnancy rate after micro-TESE and ICSI compared to men with normal BMI. Men with BMI > 43 did not contribute to any pregnancies, despite successful sperm retrieval.

  • It is very interesting that while BMI did not impact sperm retrieval rate, there was a trend toward a lower clinical pregnancy rate in larger men. It has been well proven that semen parameters change inversely with BMI. Did larger men require more testicular tissue extraction to produce similar sperm numbers to smaller men?

    • Jason Kovac

      No. Again, according to the lead author, all testes were uniformly explored independently of their BMI. Semen parameters do not necessarily correlate with ability to harvest sperm during mTESE.

  • A very interesting article that provides important information for our patients. Were there any men who underwent multiple mTESE’s where the BMI changed between attempts?

    • Jason Kovac

      According to the lead author of the study (who is sitting right beside me), these data are available and could be analyzed within minimal difficulties. I agree, it would be interesting to see if these BMI changes alter the data.

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