Figure 4.

Possible mechanisms of male infertility in metabolic syndrome (MetS). Several features of MetS may contribute to male infertility. Obesity might lead to scrotal lipomatosis and elevated scrotal temperatures, depressing sperm quality. This may be further augmented by dyslipidemia, hyperglycemia, and a proinflammatory state contributing to reactive oxygen species (ROS) formation and sperm damage. Other contributors may include elevated estrogen/testosterone ratio (E/T), erectile dysfunction (ED) and ejaculatory dysfunction (EjD). LPO, lipid peroxidation. Data from Kasturi SS et al.²²⁹