Sixiang Chen

Obesity is a major contributor to male infertility, not only exacerbating infertility but also impairing the effectiveness of both surgical interventions and medical treatments. This review examines the complex relationship between obesity, the immune microenvironment, and male infertility, highlighting how obesity-induced changes in immune function lead to testicular dysfunction and impaired spermatogenesis. Key mechanisms include chronic low-grade inflammation, immune cell infiltration, and dysregulated adipokines such as leptin and adiponectin. We also explore current therapeutic strategies aimed at alleviating these effects, including lifestyle interventions, anti-inflammatory treatments, metabolic therapies, and regenerative medicine approaches, such as exosome-based therapies. Despite promising results, substantial research gaps remain, particularly in understanding the molecular mechanisms and identifying novel biomarkers for early diagnosis. Future studies should focus on multi-omics approaches, large-scale cohort studies, the gut–testis axis, and the psychological and social factors influencing male infertility. A deeper understanding of these processes is crucial for developing more effective, targeted therapies for obesity-related male infertility.