Changes in total sperm count after gastric bypass and sleeve gastrectomy: the BARIASPERM prospective study

Background: The massive weight loss induced by bariatric surgery is associated with major benefits, but the effect on semen variables is still uncertain. Objectives: To explore semen modifications with gastric bypass and sleeve gastrectomy. Setting: Five French University Hospitals. Methods: Male candidates for bariatric surgery with no history of infertility were recruited in this controlled prospective study. Sperm characteristics were collected before surgery and then 6 months and up to 12 months after surgery. Results: Forty-six adult men who underwent gastric bypass (n = 20) or sleeve gastrectomy (n = 26) were included. Total sperm count tended to be lower at 6 months and showed a significant decrease at 12 months in both surgery groups, at -69.5 million (-96.8 to -42.2 million; P = 0.0021). Total sperm count at 12 months relative to baseline was -41.4 million (P = .0391) after gastric bypass and -91.1 million (P = .0080) after sleeve gastrectomy. This was counterbalanced by an associated resolution of hypogonadism and decrease of DNA fragmentation in most patients with time after surgery. Conclusion: Improvement in some semen variables after bariatric surgery observed in 3 previous studies is in contrast to the lower mean total sperm count found in this study at 1 year. The possible reversibility of this effect in the long term and the impact of surgery on fertility both remain unknown. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.