Diabetes (Diabetes Mellitus)

Diabetes mellitus (commonly referred to as diabetes), is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. If this condition is not properly controlled, it can entail many health risks and affect a man’s fertility in several ways.

The first step to diabetes management is a healthy diet and regular exercise. If this is not enough you will probably have to take other measures such as regularly monitoring your blood glucose levels, keeping weight and stress under control, monitoring oral medications and, if required, insulin use via injections or pump.

Usually, these diabetes management actions are sufficient to restore fertility. If this were not the case, In Vitro Fertilization coupled with Intracytoplasmic Sperm Injection (IVF + ICSI) is the best option to achieve pregnancy.

Diabetes can also damage sperm DNA by producing a high rate of DNA fragmentation. As this could affect the success rates of IVF procedures, it is advisable to perform a sperm DNA fragmentation test before starting any assisted reproduction treatment.

What is diabetes mellitus?

Diabetes mellitus is a group of metabolic diseases in which the body does not produce enough insulin or does not use it properly. Insulin is a hormone needed to convert sugar, starches and other food into energy that we need for our daily lives.

According to the World Health Organization (WHO), diabetes affects 200 million people worldwide, and it is estimated that by 2030 this number will grow to 366 million.

Diabetes mellitus is characterized by high blood sugar levels over a prolonged period. If left unchecked, it can entail many health risks and affect male fertility in several ways:

  1. About 50 percent of men with diabetes suffer from erectile dysfunction
  2. It causes ejaculatory disorders such as retrograde ejaculation and anejaculation
  3. It affects testosterone production and therefore sperm quality
  4. Diabetics have a much higher rate of sperm DNA fragmentation (around 60% more than the average male). An egg fertilized by a sperm with fragmented DNA is less likely to become a healthy embryo, affecting its uterine implantation potential and thus increasing the incidence of spontaneous abortions
  5. When this disease is not properly managed, there is a progressive decrease in sperm motility and a higher rate of sperm shape alterations

Meanwhile, women with non-controlled diabetes may present ovulation problems or be prone to cervical-vaginal infections. Similarly, prolonged high sugar blood levels can increase spontaneous abortion risk, cause birth defects and lead to excessive fetal growth (macrosomia) and birth complications.

Main diabetes mellitus symptoms

Main diabetes mellitus symptoms are:

  • Constant thirst
  • Excessive hunger
  • Frequent need to urinate
  • Unexplained weight loss
  • Hands and feet numbness
  • Blurry vision
  • Frequent infections
  • Slowly healing wounds
  • Fatigue or weakness
  • Dizziness
  • Irritability
  • Erectile dysfunction
  • Ejaculatory disorders
  • Infertility

You should contact a doctor immediately if you present any of these symptoms. A timely diabetes treatment can prevent several health problems.

Diabetes mellitus causes

Diabetes mellitus is a group of metabolic diseases in which the body does not produce enough insulin or does not use it properly.

Factors that increase the likelihood of getting diabetes include:

  • Being above 45 years old
  • Having a sedentary lifestyle
  • Bad eating habits
  • Obesity
  • Insulin resistance
  • Arterial hypertension
  • High blood cholesterol and triglycerides

It is important to know that diabetes can also be hereditary, which means men and women with parents or siblings affected by diabetes are more likely to develop it in the future.

How is diabetes mellitus diagnosed?

In addition to a patient’s physical examination and medical history review, it is necessary to perform a fasting blood glucose test. A patient with a 126 mg/dl or higher blood sugar level has diabetes and should be treated.

Diabetes mellitus patients must perform regular tests to ensure their blood sugar levels are under control.

If you have problems to conceive, are overweight or any of your relatives has diabetes, it is recommended that you perform a fasting blood glucose test to rule out the disease.

Treatments to achieve pregnancy in patients with diabetes mellitus

The first step to diabetes management is a healthy diet and regular exercise. If this is not enough to keep your blood sugar under control you will probably need to take other measures such as medication treatment (with sulfonylureas and metformin) and, if required, insulin use via injections or pump.

Usually, these diabetes management actions are sufficient to restore fertility. Diabetics under good medical supervision, with healthy body weight and normal blood glucose and cholesterol often have better semen parameters and ejaculate normally.

If this were not the case, In Vitro Fertilization coupled with Intracytoplasmic Sperm Injection (IVF + ICSI) is the best option to achieve pregnancy by making possible to inject a single sperm directly into the cytoplasm of a mature egg using a microscopic needle.

Diabetes can also damage sperm DNA by producing a high rate of DNA fragmentation. As this could affect the success rates of IVF procedures, it is advisable to perform a sperm DNA fragmentation test before starting any assisted reproduction treatment.

If the patient suffers from anejaculation, sperms can be recovered by procedures like epididymal aspiration or testicular biopsy . Meanwhile, patients with erectile dysfunction can be treated with specific medications to restore their erections.

It is important to mention that in cases of retrograde ejaculation sperms can be retrieved directly from urine and can be used (after a specific washing process) in assisted reproduction treatments.