Body Mass Index (Bmi) and Testosterone Influence on Male Partner Infertility Based on Semen Parameters in Kenyatta National Hospital Infertility and Urology Clinics in 2021

Abstract

Background: Globally, the rate of infertility is increasing rapidly with over forty-eight million five hundred couples experiencing infertility. Male infertility has been increasing with approximately 50% of couples with infertility issues being attributed to male infertility. However, male infertility has been associated with different factors. Obesity and testosterone levels among men have been associated with the development of male infertility in different settings. Thus, this study aims at investigating these factors within a Kenyan context. Aim of the study: To compare the influence of BMI and testosterone levels between fertile and infertile male partners based on Semen Analysis in Kenyatta National Hospital Infertility and Urology clinics. Methodology: This was a case-control study including clients with normal semen analysis (controls) and abnormal semen analysis (cases). The study was conducted in infertility and urology Clinics at Kenyatta National Hospital where men attending these clinics for fertility evaluation were recruited. A consecutive sampling technique was used where 22 cases and 22 controls were recruited. A structured study questionnaire was used to obtain information from the participants. The clients were required to undergo a semen analysis test, evaluation of height and weight as well as extraction of 5 ml of blood to test free testosterone and FSH levels. Results: The findings revealed that 17(77%) of controls were of normal weight compared to 7(27%) of the cases. The difference was not significant. There was no difference between the cases and controls based on marital status, monthly income, HIV status and presence of sexually transmitted diseases. There was a significant difference in testosterone levels between cases and controls (cases, 4.53(SD±1.93, controls, 6.38(SD±2.27, p = 0.006, OR =1.556). The FSH levels were higher in cases as compared to controls although the difference was not statistically significant, (cases, 7.76(SD±8.06) cases vs 4.36(SD±2.07) controls. There was no significant relationship between testosterone levels and body mass index (r = 0.291, p = 0.055). Multivariate analysis model revealed that smoking, body mass index and Testosterone level were independent predictors of male infertility based on semen analysis. Respondents who were not smokers were 92% less likely to be a case compared to being a control, (aOR = 0.081, (95%CI, 0.014, 0.478), p = 0.002). With every 1 kg/m² increase in BMI, the odds of being a case were 21% higher compared to being a control (aOR = 1.206, (95%CI, 1.036, 1.403), p = 0.016). Similarly, in every 1 ng/ml increase in testosterone level, the odds of being a case were 56% higher compared to being a control (aOR = 1.559, (95%CI, 1.099, 2.211), p = 0.013). Conclusion: The findings have shown that smoking, body mass index and testosterone levels have a significant influence on abnormal semen parameters hence there is a need to develop clear approaches to improve fertility levels through regular review of weight management to control the increased risk of abnormal semen parameters among male partners and regular physical exercises to reduce the risk of abnormal semen parameters among men.