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

Objective: To evaluate the effect of obesity on the outcome of testicular sperm extraction (TESE) and assisted reproductive technology. Design: Clinical retrospective study. Setting: Center 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/m ²) 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/m ² (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.