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

ObjectiveTo evaluate the effect of obesity on the outcome of testicular sperm extraction (TESE) and assisted reproductive technology.DesignClinical retrospective study.SettingCenter for reproductive medicine at a tertiary-care university hospital.Patient(s)Nine hundred seventy patients with nonobstructive azoospermia.Intervention(s)Microdissection TESE followed by intracytoplasmic sperm injection (ICSI).Main Outcome Measure(s)Sperm retrieval rate and clinical pregnancy rate.Result(s)Testicular sperm were successfully retrieved in 55% of men overall. Of those with sperm found, clinical pregnancy rate was 51% and live birth rate 40%. Sperm retrieval rates were similar in men with body mass index (BMI) <25 kg/m2, 25–30 kg/m2, and >30 kg/m2 (59%, 57%, and 54%, respectively). Mean BMI of men who contributed to pregnancy (27.3 ± 4.9 kg/m2) was lower than for men whose sperm did not contribute to a pregnancy (28.2 ± 5.4 kg/m2). No man with BMI >43 kg/m2 (n = 11) contributed to a successful pregnancy, even though sperm were found in men with BMI up to 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.Conclusion(s)Overweight men have lower clinical pregnancy rate after microdissection TESE and ICSI compared with men with normal BMI. Men with BMI >43 kg/m2 did not contribute to any pregnancies, despite successful sperm retrieval.