Metabolic–endocrine and epigenetic mechanisms linking obesity to male infertility: a narrative review

Obesity is a globally prevalent chronic condition and a well-recognized metabolic disorder associated with systemic metabolic dysregulation and various diseases. In recent years, growing evidence suggests that obesity also plays a significant role in male reproductive dysfunction. This narrative review was based on a targeted literature search primarily conducted in PubMed using combinations of keywords. Priority was given to recent high-quality clinical and experimental studies, and seminal earlier studies and additional relevant references from key articles were also included. Current evidence indicates that obesity impairs male reproductive health through multiple interconnected mechanisms, including adipokine dysregulation, chronic inflammation, insulin resistance, endocrine imbalance, impaired spermatogenesis, and sperm epigenetic remodeling. However, findings regarding paternal obesity and assisted reproductive technology (ART) outcomes remain inconsistent, although some studies suggest potential associations with adverse offspring outcomes. Lifestyle modification and pharmacological interventions can partially improve obesity-associated reproductive impairment, underscoring male obesity as a modifiable risk factor. In summary, by integrating metabolic, endocrine, and epigenetic perspectives, this review provides a mechanistic framework to better understand obesity-related male infertility and to inform future clinical and translational research.

Obesity; Male fertility; Sperm epigenetics; Endocrine dysfunction

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