SFEBES2026 Poster Presentations Reproductive Endocrinology (14 abstracts)
1The University Hospitals of Leicester, Leicester, United Kingdom; 2University of Leicester, Leicester, United Kingdom
Introduction: Obesity-related functional hypogonadotropic hypogonadism is increasingly recognized as a significant contributor to male subfertility, manifesting impairment in semen parameters and hormonal disruptions. Treatment options remain limited, underscoring an unmet clinical need. We present a case demonstrating significant fertility improvement with targeted obesity pharmacotherapy.
Case: A 42-year-old man presented with a 3-year history of infertility, obesity (BMI 40.6; 123 kg), T2DM, and erectile dysfunction (ED). Evaluation showed hypogonadotropic hypogonadism (FSH 6.9, LH 4.9 IU/l), low testosterone (3.2), low SHBG (19), and normal remaining pituitary function. Semen analysis confirmed azoospermia. He lost 6.3 kg on Semaglutide (Ozempic) over 3 months and further 10 kg on Tirzepatide (Mounjaro), reducing BMI from 40.6 to 32.1 in 8 months. ED symptoms and semen parameters improved. His partner achieved natural conception 8 months after obesity pharmacotherapy, resulting in a healthy baby girl.
| Parameter | Baseline | Post-weight loss | Normal range |
| BMI | 40.6 | 32.1 | 18.5-24.9 kg/m2 |
| Testosterone | 3.2 | 7.4 | 11.5-54.5 nmol/l |
| LH | 4.9 | 2 | 1.5-9.3 iu/l |
| FSH | 6.9 | 4.9 | 1.4-18.1 iu/l |
| SHBG | 19 | 22 | 11.5-54.5 nmol/l |
| Inhibin B | 111.5 | 25-325 pg/ml | |
| Semen analysis | |||
| pH | 8 | 8.1 | 7.2-8.0 |
| Volume | 1.5 | 5.3 | 1.4 ml |
| Concentration | 0 | 31 | 16million/ml |
| Morphology | 0 | 2% | 4% |
| Motility | 0 | 39% | > 30% |
| Total sperm number | 0 | 164.3 | > 40million |
Discussion: Reduced fat mass lowers aromatase activity, decreasing androgen-to-oestrogen peripheral conversion and improving the testosteroneoestrogen ratio essential for spermatogenesis. Direct stimulation of testicular receptors by GIP and GLP-1 enhances Leydig cell function, promoting testosterone synthesis and spermatogenesis. We are currently recruiting for a male fertility sub-study investigating the impact of Tirzepatide-induced weight loss on male reproductive health.
Learning points: 1. Fat mass reduction & potential direct stimulation of GLP1 & GIP receptors can improve male fertility outcomes in obesity induced hypogonadism. 2. GLP-1 or dual GLP-1/GIP agonists may offer therapeutic option for male infertility.