Weight Loss Impact on Male Fertility

Significative Weight Loss Impact on Oxidative Stress, Metabolic, Hormonal, Inflammatory and Seminal Parameters of Obese Men.

This is a prospective non-randomized unicentric clinical trial, characterized by the inclusion of obese (BMI> 35) male with subfertility (sperm count showing low sperm counts and / or motility and / or morphology and / or DNA fragmentation). Patients selected at the endocrinology obesity HC-FMUSP outpatient will be submitted to very low calorie diet (VLCK) for 6 months, being reassessed clinically and laboratorially monthly.

Patients will be submitted to very low-calorie ketogenic dietary intervention (VLCK) according to the recommendations of the Pronokal® Method program including lifestyle and physical activity guidelines. The ketogenic stage (phase 1-3) consists of a VLCD diet (600-800 kcal / d), with low carbohydrate intake and lipids. The amount of high biological value proteins ranges from 0.8 to 1.2 g / kg of body weight / day. This first stage (ketogenic) is maintained until the patient reaches the goal of reducing the target weight by 80% to be reduced, being variable in time, according to the response of each patient. After this period, it evolved to a non-ketogenic stage, initiating the hypocaloric diet (800 to 1500 Kcal), with progressive introduction of other food groups, reducing weight more slowly. The maintenance stage consists of a balanced diet, ranging from 1500 to 2000 Kcal.

To evaluate adipokines: leptin, adiponectin, UCP-1, FGF21, irisin and PGC1a measures before and after intervention.

Inclusion Criteria: Obesity in male patients Metabolic Syndrome (NCEP-ATP III) Alteration of some of the seminal parameters evaluated in conventional seminal analysis Exclusion Criteria: Other causes of hypogonadotrophic hypogonadism Hypergonadotrophic hypogonadism Contraindications for performance of ketogenic diet: Type 1 or type 2 diabetes mellitus in insulin use Food drive Alcoholism or drug addiction Severe psychiatric illness Use of coumarin anticoagulants Hepatic insufficiency Severe renal impairment Hematologic diseases Cancer in activity, Cardiovascular or cerebrovascular diseases (arrhythmias, recent myocardial infarction, unstable angina, decompensated heart failure, recent stroke) Gout Renal or biliary lithiasis Major depression or other serious psychiatric illness.