On World Diabetes Day we want to talk about how this metabolic disease affects fertility. Actually, much has been said about how it affects female fertility, but what about the male? The reality is that there is not much information about it. According to data from INE Diabetes affects 8.2% of the male population in Spain. For this reason, we have asked Dr. Manuel Muñoz, director of IVI Alicante and the Center of Excellence in Ovarian Rejuvenation, to talk to us about how diabetes affects men’s fertility.
Impact of diabetes on semen quality
Although not much is said about it, the reality is that diabetes can affect a man’s fertility. This can negatively affect the moment of sperm maturation, as well as its development and functional capacity. Therefore, it will lead to an impact on the chances of achieving pregnancy with said gametes. But why does this happen? Because the sperm of men with diabetes age prematurely. This is due to the high concentration of reactive oxygen species in the male reproductive system. This causes oxidative stress in the environment of the male gametes and, therefore, affects male fertility.
The way we have to measure male fertility is through the seminogram. But the reality is that no changes are observed in this test, but a decrease in fertility in men with this metabolic disease. But it is also worth mentioning that it is treated, mostly, in patients who do not have controlled diabetes.
Lower fertilization capacity
This decrease in the fertile potential of the man due to diabetes will be revealed by having a low capacity to achieve fertilization. Or, in those cases in which it is achieved, the pregnancy may not reach term and end in implantation failure, miscarriage or increased risk of genetic alterations transmittable to their offspring. In this type of patients there is less ability to repair the genetic material. This leads us to increase the chances that the sperm DNA fragmentation index is higher, even when the sperm concentration and motility variables are within normal values.
diabetes and sexual function
But what has been said so far is not all we can say on this subject. And it is that if we do not control diabetes in men, sexual function can also be compromised. And, therefore, also fertility. Some of these problems that can appear due to diabetes are: erectile dysfunction, ejaculation disorders or hypogonadism. The latter is a shortage of testosterone, with associated symptoms, a deficit in sperm production, or both.
What solutions can we apply?
The first thing we have to control is the diabetes itself. For this it is essential to lead a healthy lifestyle, which makes us have an adequate weight. The reality is that diabetes cannot be modified, but some external aspects mean that we do not have it under control. From an inadequate diet and obesity, to the consumption of tobacco, alcohol and other harmful substances. The first medical recommendation will always be to introduce healthy habits on a daily basis. Practice some sport on a regular basis, avoiding the consumption of alcohol or other harmful substances. These small changes in lifestyle will positively affect male fertility.
And from the medical aspect?
We can perform medical tests to measure testosterone levels in patients with erectile dysfunction. A spermiogram will allow us to evaluate the quantity, mobility and morphology of the sperm. On the other hand, in cases of suspicion that the DNA structure is altered, it may be necessary to carry out complementary tests. These would consist of genetic analysis of Y chromosome microdeletions, sperm DNA fragmentation and sperm oxidative stress.
The fundamental thing is to control the diabetes, so that there are less probabilities that variables that affect fertility appear. The general diagnosis of patients with this pathology usually improves when glucose levels are controlled or the body mass index decreases, for example. However, our recommendation will always be to go to a specialist who assesses each case in a personalized way and issues an individual recommendation.
