Obesity fertility male

Obesity and Male Fertility: What It Means

Obesity and male fertility refers to the way excess body fat can affect a man’s ability to produce healthy sperm, maintain balanced reproductive hormones, have reliable erections, and contribute to a pregnancy. Obesity does not automatically mean a man is infertile, but it is a well-recognized risk factor for lower semen quality, reduced testosterone, erectile dysfunction, and longer time to conception.

For men who are trying to conceive, body weight is not just a general health issue. Fat tissue is hormonally active. It can influence testosterone, estrogen, insulin, inflammation, oxidative stress, and even scrotal temperature — all of which can matter for sperm production and sexual function.

Table of Contents

• Obesity and Male Fertility: What It Means
• Why Obesity Matters for Male Reproductive Health
• How Obesity Can Affect Male Fertility
• Obesity and Sperm Health
• Obesity, Testosterone, and Hormones
• Weight, Erectile Function, and Libido
• Testing to Consider if You’re Trying to Conceive
• What’s Normal vs. What’s Not?
• How to Improve Fertility When Obesity Is a Factor
• Medical Treatments and Fertility-Specific Options
• Questions to Ask Your Doctor
• Common Myths About Obesity and Male Fertility
• FAQs
• References

Why Obesity Matters for Male Reproductive Health

Male fertility depends on a coordinated system: the brain signals the testes, the testes produce testosterone and sperm, the reproductive tract transports sperm, and sexual function allows sperm delivery. Obesity can influence several points in this system at once.

Body fat is not passive storage. It acts like an endocrine organ, meaning it produces and modifies hormones and inflammatory signals. In men with obesity, this can contribute to:

• Lower total testosterone and sometimes lower free testosterone
• Higher conversion of testosterone into estrogen through aromatase activity in fat tissue
• Insulin resistance and altered glucose metabolism
• Chronic low-grade inflammation
• Higher oxidative stress, which can damage sperm cell membranes and DNA
• Sleep apnea and poorer sleep quality, which can affect testosterone and energy
• Higher risk of erectile dysfunction and reduced libido

These changes do not affect every man in the same way. Some men with obesity have normal semen analyses and conceive without difficulty. Others may have abnormal sperm concentration, motility, morphology, hormone results, or sexual function. The key is to evaluate the full picture rather than assume weight alone explains everything.

How Obesity Can Affect Male Fertility

Obesity can influence male fertility through several overlapping biological pathways. Understanding these mechanisms helps explain why weight, metabolic health, and reproductive function are connected.

Pathway	How obesity may affect it	Possible fertility impact
Hormonal disruption	Excess fat tissue can increase aromatase activity, converting more testosterone into estrogen. Obesity is also linked with lower sex hormone-binding globulin and lower measured testosterone.	Lower sperm production, lower libido, fatigue, and sexual function issues in some men.
Insulin resistance	Obesity increases the risk of insulin resistance, prediabetes, and type 2 diabetes.	May impair testosterone production, erectile function, and sperm quality.
Oxidative stress	Chronic inflammation and metabolic dysfunction can increase reactive oxygen species.	Potential damage to sperm membranes and sperm DNA, which may affect fertilization and embryo development.
Scrotal heat	Increased fat around the thighs, groin, and abdomen may raise local heat exposure. The testes need to stay cooler than core body temperature for optimal sperm production.	Possible reduction in sperm production and motility.
Sleep apnea	Obesity is a major risk factor for obstructive sleep apnea, which fragments sleep and affects oxygen levels.	May contribute to lower testosterone, low energy, and erectile dysfunction.
Sexual function	Obesity is associated with vascular disease, lower testosterone, depression, medication use, and diabetes, all of which can affect erections.	Difficulty with intercourse timing, reduced frequency, or ejaculation problems.

Obesity and Sperm Health

Semen quality is one of the most direct ways to evaluate male fertility. A standard semen analysis looks at the number of sperm, how they move, their shape, semen volume, and other features. Obesity has been associated in many studies with poorer semen parameters, but the relationship is not perfectly predictable for every individual.

Sperm count and concentration

Sperm concentration is the number of sperm per milliliter of semen. Total sperm count considers both semen volume and concentration. Men with obesity may be at higher risk of a lower sperm concentration or lower total sperm count, especially when obesity is accompanied by metabolic syndrome, diabetes, low testosterone, or other reproductive conditions.

Sperm motility

Sperm motility describes how well sperm move. Progressive motility — sperm moving forward effectively — is especially important because sperm must travel through the female reproductive tract to reach an egg. Oxidative stress, inflammation, heat exposure, and metabolic dysfunction may all contribute to reduced motility.

Sperm morphology

Sperm morphology refers to sperm shape. A semen analysis estimates the percentage of sperm with a normal form. Morphology can be influenced by many factors, including varicocele, heat, illness, medications, toxin exposure, and lifestyle. Obesity may be one contributor, but morphology alone rarely tells the whole fertility story.

Sperm DNA fragmentation

Sperm DNA fragmentation measures breaks or damage in sperm DNA. It is not part of every routine semen analysis, but it may be considered in certain cases, such as unexplained infertility, recurrent pregnancy loss, repeated IVF failure, advanced paternal age, varicocele, smoking, or significant oxidative stress risk.

Obesity-related inflammation and oxidative stress may increase the risk of sperm DNA damage. However, testing and interpretation should be individualized because DNA fragmentation results do not always translate directly into a single treatment plan.

Obesity, Testosterone, and Hormones

One of the most important links between obesity and male fertility is the hormone system known as the hypothalamic-pituitary-gonadal axis. This system connects the brain and testes through hormonal signals.

In simple terms:

1. The hypothalamus in the brain releases GnRH.
2. The pituitary gland releases LH and FSH.
3. LH signals the testes to produce testosterone.
4. FSH supports sperm production inside the testes.

Obesity can disrupt this system in several ways. Fat tissue contains aromatase, an enzyme that converts testosterone into estradiol, a form of estrogen. Higher levels of body fat can also be associated with lower sex hormone-binding globulin, which affects total testosterone measurements. Insulin resistance, inflammation, and sleep problems may further interfere with normal testosterone production.

Hormone or marker	Why it matters for male fertility	How obesity may be involved
Total testosterone	Supports libido, erections, energy, and sperm production indirectly through testicular function.	Often lower in men with obesity, partly due to lower SHBG and altered hormonal signaling.
Free testosterone	The biologically available portion of testosterone.	May be low in some men with obesity, especially with metabolic disease.
LH	Stimulates testosterone production in the testes.	Can help distinguish primary testicular problems from brain-pituitary signaling issues.
FSH	Supports sperm production.	High FSH can suggest impaired sperm production; low or normal FSH with low testosterone may suggest hormonal suppression.
Estradiol	Men need some estrogen, but excess can affect hormonal balance.	May be higher with increased aromatase activity in fat tissue.
Prolactin	High prolactin can reduce libido and suppress reproductive hormones.	Not caused by obesity alone, but may be checked if testosterone is low or symptoms suggest it.

A key caution: testosterone replacement therapy can reduce or shut down sperm production. Men who want future fertility should not start testosterone therapy without discussing fertility-preserving alternatives with a urologist, reproductive urologist, or qualified clinician.

Weight, Erectile Function, and Libido

Male fertility is not only about sperm. It also depends on the ability to have intercourse at the right time in the fertile window. Obesity can increase the risk of erectile dysfunction and reduced sexual desire through vascular, hormonal, neurological, and psychological pathways.

Common contributors include:

• Reduced blood vessel function: Erections depend on healthy blood flow. Obesity, high blood pressure, diabetes, and high cholesterol can all impair vascular health.
• Lower testosterone: Low testosterone can reduce libido and may contribute to weaker erections in some men.
• Sleep apnea: Poor sleep quality and oxygen disruption can affect testosterone, mood, and sexual performance.
• Medication effects: Some blood pressure medications, antidepressants, and other prescriptions can affect erections or ejaculation.
• Mental health stress: Fertility pressure, body image concerns, anxiety, and depression can all affect sexual function.

Erectile dysfunction can also be an early warning sign of cardiovascular disease. Men who develop persistent erection problems, especially with risk factors such as obesity, diabetes, smoking, high blood pressure, or a family history of heart disease, should seek medical evaluation.

Testing to Consider if You’re Trying to Conceive

If pregnancy has not happened after 12 months of regular unprotected intercourse — or after 6 months if the female partner is 35 or older — both partners should be evaluated. Men with known risk factors, abnormal sexual function, prior testicular issues, or a history of infertility may benefit from earlier testing.

Semen analysis

A semen analysis is the first-line test for male fertility. It is usually collected after 2 to 7 days of abstinence, depending on the lab’s instructions. Because sperm results can fluctuate, abnormal findings are often repeated before major decisions are made.

A semen analysis commonly measures:

• Semen volume
• Sperm concentration
• Total sperm number
• Motility and progressive motility
• Morphology
• pH, viscosity, liquefaction, and sometimes white blood cells

Hormone testing

Hormone testing may be recommended if semen results are abnormal, libido is low, erections are affected, testicular size is reduced, or symptoms suggest low testosterone. Morning blood testing is often used because testosterone levels vary throughout the day.

Common tests include:

• Total testosterone, ideally measured in the morning
• Free testosterone or calculated free testosterone when appropriate
• LH and FSH
• Estradiol
• Prolactin
• Thyroid-stimulating hormone if symptoms suggest thyroid disease

Metabolic and general health testing

Because obesity-related fertility concerns often overlap with metabolic health, clinicians may also evaluate:

• Hemoglobin A1c or fasting glucose
• Fasting lipid panel
• Blood pressure
• Liver enzymes if fatty liver disease is a concern
• Sleep apnea symptoms, such as snoring, daytime sleepiness, or witnessed breathing pauses

Additional fertility testing

Depending on history and results, a clinician may discuss sperm DNA fragmentation testing, scrotal ultrasound, genetic testing, post-ejaculatory urine testing, or referral to a reproductive urologist.

What’s Normal vs. What’s Not?

There is no single body weight at which fertility suddenly becomes normal or abnormal. Risk tends to rise as excess body fat, waist circumference, insulin resistance, inflammation, sleep apnea, and hormonal disruption increase. The same BMI can also mean different things in different men depending on muscle mass, ethnicity, fat distribution, and metabolic health.

Measure	Common reference categories	Fertility relevance
Body mass index	Overweight: BMI 25.0–29.9; obesity: BMI 30.0 or higher, based on standard adult BMI categories.	BMI is a screening tool, not a diagnosis of fertility status. Higher BMI is associated with increased reproductive and metabolic risk.
Waist circumference	Higher cardiometabolic risk is often associated with a waist circumference above 40 inches in men, though cutoffs can vary by population.	Abdominal fat is closely linked with insulin resistance, inflammation, and lower testosterone.
Semen analysis	Reference limits depend on the lab and WHO manual used.	A “normal” semen analysis does not guarantee fertility, and an abnormal result does not mean pregnancy is impossible.
Testosterone	Ranges vary by lab and assay. Morning testing and repeat confirmation are often important.	Low testosterone plus symptoms may need evaluation, but fertility goals change treatment choices.
Metabolic health	Blood pressure, A1c, fasting glucose, cholesterol, and triglycerides help assess cardiometabolic risk.	Metabolic syndrome and diabetes can affect hormones, erections, and sperm quality.

If you are trying to conceive, the most useful question is not simply “Is my BMI normal?” A better question is: Are my sperm parameters, hormones, sexual function, and metabolic markers supporting fertility?

How to Improve Fertility When Obesity Is a Factor

Improving fertility when obesity is involved usually requires a broader strategy than “lose weight.” The goal is to improve the biological environment for sperm production: better metabolic health, lower inflammation, better sleep, healthier hormone signaling, improved vascular function, and less heat or oxidative stress.

1. Aim for sustainable weight loss, not crash dieting

Even modest, sustained weight loss can improve insulin sensitivity, blood pressure, sleep apnea risk, and testosterone in many men. However, extreme calorie restriction, rapid weight loss, or poorly planned diets may temporarily stress the body and may not support sperm quality.

A practical target is steady progress over months, using an approach you can maintain. Because sperm development takes roughly 2 to 3 months, semen changes may lag behind improvements in weight, sleep, and lab markers.

2. Prioritize protein, fiber, and minimally processed foods

A fertility-supportive eating pattern is less about a single “male fertility diet” and more about metabolic consistency. Many men benefit from:

• Lean proteins such as eggs, fish, poultry, Greek yogurt, legumes, tofu, or lean meats
• High-fiber carbohydrates such as oats, beans, lentils, vegetables, fruit, and whole grains
• Healthy fats from olive oil, nuts, seeds, avocado, and fatty fish
• Reduced intake of sugary drinks, refined snacks, and ultra-processed foods
• Consistent meal timing if it helps with appetite and glucose control

There is no need for perfection. The best nutrition plan is one that improves health markers and is realistic enough to maintain during a stressful fertility journey.

3. Use exercise to improve insulin sensitivity and testosterone-supportive health

Exercise can improve fertility-related health even before major weight loss occurs. A balanced plan often includes:

• Resistance training: 2 to 4 sessions per week to build or maintain muscle mass.
• Aerobic activity: Brisk walking, cycling, swimming, or similar activity most days of the week.
• Daily movement: More steps, less sitting, and regular movement breaks.

Very high-volume endurance training, overheating, inadequate recovery, or restrictive dieting can be counterproductive for some men. The goal is sustainable fitness, not exhaustion.

4. Protect sleep and screen for sleep apnea

Sleep is a major reproductive health factor. Testosterone production is linked with sleep quality, and obstructive sleep apnea is common in men with obesity. Warning signs include loud snoring, waking up gasping, morning headaches, daytime sleepiness, and a partner noticing breathing pauses.

If sleep apnea is suspected, evaluation and treatment may improve energy, cardiometabolic health, and sexual function. Do not ignore severe snoring or daytime sleepiness during fertility planning.

5. Reduce heat exposure to the testes

Sperm production is temperature-sensitive. Men trying to conceive may consider reducing avoidable heat exposure, especially if semen results are abnormal.

• Avoid frequent hot tubs, saunas, or very hot baths during active fertility efforts.
• Take movement breaks if sitting for long periods.
• Avoid placing laptops directly on the lap.
• Choose underwear and clothing that feel comfortable and not excessively tight or heat-trapping.

6. Limit alcohol and avoid smoking or anabolic steroids

Smoking, heavy alcohol use, cannabis, and anabolic-androgenic steroids can affect sperm and hormones. Anabolic steroids and non-prescribed testosterone are especially important: they can suppress the brain’s signal to the testes and severely reduce sperm production.

If you have used anabolic steroids or testosterone and want fertility, speak with a reproductive urologist. Recovery is possible in many cases, but it may take time and may require medical treatment.

7. Consider supplements carefully

Some antioxidant supplements are marketed for male fertility, including CoQ10, zinc, selenium, vitamin C, vitamin E, carnitine, and omega-3 fatty acids. Evidence varies, and supplements are not a substitute for identifying medical causes of infertility.

Before starting supplements, consider reviewing your semen analysis, medications, diet, and health history with a clinician. More is not always better, and some supplements can interact with medications or be inappropriate at high doses.

Medical Treatments and Fertility-Specific Options

When obesity is part of a fertility issue, treatment depends on the man’s semen results, hormone profile, timeline, age of the female partner, and any other diagnoses. The right plan may combine lifestyle changes, medical care, and assisted reproductive technology.

Weight management medications

Prescription weight management medications may be appropriate for some men with obesity, especially when lifestyle changes alone have not been enough or when obesity-related conditions are present. These medications should be discussed with a qualified clinician, particularly when trying to conceive, because data on direct fertility effects may vary by medication and individual situation.

Bariatric surgery

Bariatric surgery can lead to major weight loss and improvements in diabetes, blood pressure, sleep apnea, and testosterone in many patients. However, effects on semen quality are more variable. Rapid weight loss, nutrient deficiencies, and major metabolic shifts may temporarily affect sperm production in some men.

Men considering bariatric surgery who want biological children should discuss fertility timing, semen analysis, nutritional monitoring, and sperm banking with their medical team.

Treatment for low testosterone when fertility is desired

If a man has low testosterone and wants future fertility, clinicians may consider fertility-preserving options rather than testosterone replacement. Depending on the diagnosis, these may include medications that stimulate the body’s own testosterone and sperm production pathways. These treatments require medical supervision and are not appropriate for every case.

Erectile dysfunction treatment

If erections are making timed intercourse difficult, treatment can improve the chances of pregnancy and quality of life. Options may include lifestyle changes, management of diabetes or blood pressure, medication review, oral PDE5 inhibitors, counseling, or other therapies. Persistent erectile dysfunction deserves evaluation, not embarrassment.

Assisted reproductive technology

If semen parameters are significantly abnormal or time is limited, a fertility specialist may discuss:

• Intrauterine insemination: Prepared sperm are placed in the uterus near ovulation.
• In vitro fertilization: Eggs are fertilized with sperm in a lab.
• Intracytoplasmic sperm injection: A single sperm is injected into an egg, often used when sperm numbers or motility are very low.
• Sperm retrieval procedures: Used in certain cases of very low or absent sperm in the ejaculate.

Assisted reproduction can help bypass some barriers, but improving overall male health may still matter for sperm quality, pregnancy planning, and long-term wellbeing.

Questions to Ask Your Doctor

If you are concerned about obesity and male fertility, consider bringing specific questions to your clinician, urologist, or reproductive endocrinology team.

• Should I get a semen analysis now, or wait until we have tried longer?
• Do my semen results suggest a repeat test or referral to a reproductive urologist?
• Should I have morning testosterone, LH, FSH, estradiol, or prolactin checked?
• Could sleep apnea, diabetes, blood pressure, or cholesterol be affecting my fertility?
• Are any of my medications affecting erections, ejaculation, hormones, or sperm?
• If my testosterone is low, what options preserve fertility?
• Would sperm DNA fragmentation testing be useful in my situation?
• Should I consider sperm banking before major weight loss treatment, testosterone-related treatment, or surgery?
• What timeline makes sense given my partner’s age, reproductive history, and our goals?

Related Tests and Terms

Understanding obesity and male fertility often means understanding several connected terms. These are commonly discussed during a male fertility evaluation.

Term	Meaning	Why it matters
Semen analysis	A lab test that evaluates sperm and semen characteristics.	First-line test for male fertility.
Oligozoospermia	Low sperm concentration.	Can reduce the chance of natural conception.
Asthenozoospermia	Reduced sperm motility.	Sperm may have difficulty reaching the egg.
Teratozoospermia	Low percentage of normally shaped sperm.	May affect fertilization potential, depending on the whole semen profile.
Azoospermia	No sperm seen in the ejaculate.	Requires specialist evaluation to determine whether sperm production or blockage is the issue.
Hypogonadism	Low testosterone with symptoms and supportive lab findings.	Treatment choice depends heavily on fertility goals.
Metabolic syndrome	A cluster of abdominal obesity, high blood pressure, abnormal cholesterol or triglycerides, and elevated blood sugar.	Linked with lower testosterone, erectile dysfunction, and reproductive risk.
Sperm DNA fragmentation	A measure of DNA damage in sperm.	May be considered in selected infertility cases.

Common Myths About Obesity and Male Fertility

Myth: If a man has obesity, he is infertile.

Not true. Many men with obesity can and do conceive naturally. Obesity is a risk factor, not a diagnosis of infertility. Testing is the only way to know whether sperm parameters or hormones are affected.

Myth: If a semen analysis is normal, weight does not matter.

A normal semen analysis is reassuring, but it does not capture every aspect of reproductive or metabolic health. Weight-related issues such as erectile dysfunction, sleep apnea, diabetes, and low testosterone can still matter for conception and long-term health.

Myth: Testosterone therapy is the fastest way to improve male fertility.

This is one of the most important misconceptions. Testosterone replacement can suppress LH and FSH, the hormones that signal the testes to make sperm. Men trying to conceive should avoid testosterone therapy unless a fertility-aware clinician has clearly explained the risks and alternatives.

Myth: Only the female partner needs fertility testing.

Male factors contribute to a substantial portion of infertility cases. A semen analysis is noninvasive, relatively accessible, and often provides useful information early in the process.

Myth: Weight loss fixes every fertility issue.

Weight loss may help, especially when metabolic health or hormones improve, but it will not correct every cause of male infertility. Varicoceles, genetic conditions, obstruction, prior infections, medication effects, and testicular injury may need separate evaluation.

When to See a Doctor

Consider medical evaluation if any of the following apply:

• You have been trying to conceive for 12 months without pregnancy.
• You have been trying for 6 months and the female partner is 35 or older.
• You have erectile dysfunction, low libido, ejaculation problems, or symptoms of low testosterone.
• You have a history of undescended testicle, testicular surgery, chemotherapy, radiation, pelvic surgery, or significant testicular injury.
• You have diabetes, sleep apnea symptoms, high blood pressure, or metabolic syndrome.
• You have used testosterone, anabolic steroids, or performance-enhancing hormones.
• A semen analysis shows low sperm count, poor motility, abnormal morphology, or no sperm.
• You and your partner have a history of recurrent pregnancy loss or failed fertility treatment.

Early evaluation does not mean you are committing to aggressive treatment. It means you are gathering information while there is still time to act strategically.

FAQs About Obesity and Male Fertility

Can obesity cause male infertility?

Obesity can contribute to male infertility, but it is not the only cause and does not make every man infertile. It may affect sperm production, testosterone levels, erectile function, inflammation, oxidative stress, and metabolic health. A semen analysis and hormone evaluation can help determine whether fertility is affected.

Does losing weight improve sperm count?

Weight loss may improve sperm count or other semen parameters in some men, especially when it improves testosterone, insulin resistance, inflammation, sleep apnea, or overall metabolic health. Results vary, and improvements may take at least 2 to 3 months because sperm production takes time.

How does obesity affect testosterone?

Obesity is commonly associated with lower total testosterone and sometimes lower free testosterone. Fat tissue can increase conversion of testosterone to estrogen, while insulin resistance, inflammation, and poor sleep may further disrupt hormone signaling. Testosterone should usually be checked with a morning blood test and interpreted with symptoms and other hormones.

Can belly fat affect sperm?

Abdominal fat is closely linked with insulin resistance, inflammation, and lower testosterone, all of which may affect sperm production or function. Waist circumference can sometimes provide useful health context beyond BMI alone.

Can obesity cause erectile dysfunction?

Yes, obesity can increase the risk of erectile dysfunction through reduced vascular health, diabetes, high blood pressure, low testosterone, sleep apnea, medication effects, and psychological stress. Persistent erection problems should be medically evaluated because they may also signal cardiovascular risk.

How long after weight loss can sperm improve?

Sperm development takes roughly 2 to 3 months, and additional time is needed for sperm to mature and appear in the ejaculate. Many clinicians look for changes over a 3- to 6-month window after meaningful lifestyle or medical improvements, although timing varies.

Is BMI the best measure for male fertility risk?

BMI is a useful screening tool, but it is not a complete measure of fertility risk. Waist circumference, metabolic labs, sleep quality, hormone levels, semen analysis, medications, and sexual function often provide a more complete picture.

Can testosterone treatment help an overweight man conceive?

Usually not. Testosterone replacement therapy can suppress the hormones needed for sperm production and may lower sperm count dramatically. Men who want fertility should ask about fertility-preserving approaches before using testosterone.

Should men with obesity get a semen analysis before trying to conceive?

Not every man needs testing before trying, but early semen analysis can be reasonable if there are additional risk factors, such as low libido, erectile dysfunction, prior testicular problems, diabetes, steroid or testosterone use, or a partner with age-related fertility concerns. It is also recommended as part of an infertility evaluation when pregnancy has not occurred after the appropriate timeframe.

Can bariatric surgery improve male fertility?

Bariatric surgery can improve weight, diabetes, sleep apnea, and testosterone in many men. Effects on semen quality are more variable, and rapid weight loss or nutrient deficiencies may temporarily affect sperm. Men planning surgery and future fertility should discuss semen testing, nutritional monitoring, and sperm banking with their care team.

References

• World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen, 6th edition.
• Centers for Disease Control and Prevention. Adult BMI categories and obesity definitions. https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html
• American Urological Association and American Society for Reproductive Medicine. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline. https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility
• Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertility and Sterility.
• National Institute of Diabetes and Digestive and Kidney Diseases. Health risks of overweight and obesity. https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks
• Endocrine Society. Testosterone therapy in men with hypogonadism: clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism.
• European Association of Urology. Guidelines on Sexual and Reproductive Health. https://uroweb.org/guidelines/sexual-and-reproductive-health