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

Abstract 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 (GB) and sleeve gastrectomy (SG). 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 then six months and up to 12 months after surgery. Results Forty-six adult men who underwent GB (n = 20) or SG (n = 26) were included. Total sperm count (TSC) tended to be lower at 6 months and showed a significant decrease at 12 months in both surgery groups -69.5 millions (-96.8 to -42.2 millions ; p = 0.0021). TSC at 12 months relative to baseline was -41.4 millions ( p = 0.0391) following GB and -91.1 millions ( p = 0.0080) following SG. 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 one year. The possible reversibility of this effect at long-term and the impact of surgery on fertility both remain unknown.