Researchers and medical experts have established a direct link between diabetes and fertility in both men and women. Fluctuating blood sugar levels has been directly linked to multiple conditions either directly or indirectly, especially in those suffering from chronic diabetes.
“In men, uncontrolled diabetes can affect the sperm quality leading to defective sperm, reduced motility etc,” shares Dr Rajeshwari Janakiraman, chief consultant, diabetology, endocrinology, Manipal Hospital, Yeshwanthpur, Bengaluru. “Poorly controlled long-term diabetes can impact the nerves and blood circulation leading to erectile dysfunction and retrograde ejaculation (when semen enters the bladder). Psychological issues like anxiety and diabetes distress may also contribute to infertility by reduced sexual drive,” she points out.
A study titled ‘The effects of diabetes on male fertility and epigenetic regulation during spermatogenesis’ disclosed the effects of high glucose levels in the production of sperm (a process called spermatogenesis) and how it disturbs the male reproductive system.
Dr Dilip Dhanpal, senior urologist and transplant surgeon, Sagar Hospital, Bengaluru, says that the reverse is also true. “Those being investigated for decreased semen volume, sperm count and sperm motility have a higher incidence of diabetes, cardiovascular diseases and obesity,” he asserts.
Both types of diabetes – type 1 and 2 are chronic and have life-long effects on the organs. They can affect fertility too.
“In women, type 1 or juvenile diabetes can cause irregular menstruation, delayed menarche (the first period), anovulatory cycles (when the ovaries don’t release the egg which is required for a woman to get pregnant) with low body mass index (BMI) and disruption in hormones of the hypothalamic-pituitary axis (which controls our central stress response),” shares Dr Sunayna Rao, consultant gynaecologist, obstetrician and laparoscopy surgeon, Suvidha Nursing Home, Honavar, Karnataka.
“In men, anti-sperm antibodies may also play a role as an autoimmune factor. Type 2 diabetes is slowly increasing in the reproductive age group as a result of increasing obesity and lifestyle changes,” she adds.
The ‘History of infertility and risk of type 2 diabetes mellitus: a prospective cohort study’ evaluated the relationship between delayed conception and type 2 diabetes risk. It was found that a history of infertility, particularly that related to ovulation disorders and tubal blockage is significantly associated with a higher risk of type 2 diabetes.
Dr Arunima Haldar, consultant, IVF and reproductive medicine, Manipal Hospital, Varthur, Bengaluru, points out the typical effects of diabetes on fertility:
In men
- Erectile dysfunction
- Decreased libido
- Decreased sperm motility
- Increased account of broken or fragmented DNA in sperm (high DNA fragmentation index or DFI). This can lead to embryo arrest, implantation pulse (hinders embryo implantation) as well as an early miscarriage
- Decreased ability of sperm to fertilise eggs
- Abnormal sperm morphology (the size and shape of the sperm)
- Advanced glycation end products (AGEs are harmful substances that form when protein or fat combine with sugar in the bloodstream) from high blood sugar can cause genetic modification of sperm DNA. This can lead to metabolic disease when offspring are older
- Diabesity: coexistence of diabetes and obesity
In women
- Menstrual irregularities
- Association of auto-immune disorders like Hashimoto’s thyroiditis. This may be associated with anti-ovarian antibodies. It can cause premature menopause
- Decreased libido
- Polycystic ovarian disease like foetal and hyperandrogenism (high levels of androgens)
Preventing diabetes-led infertility
Well-controlled diabetes and the right treatment can give hope to diabetics who wish to have a baby, say experts.
“Precious time is lost when diabetic couples who have difficulty in conceiving delay seeking treatment. The best bet yet is insulin and not medications. Some medications for diabetes can affect fertility; insulin is a hormone and has no side effects,” advises Dr Mohan Badgandi, consultant diabetologist and endocrinologist, Manipal Hospital, Airport Road, Bengaluru.
Controlling blood sugar and bringing HbA1C to an ideal level – below six per cent is important, says Dr Rao. “In addition to this, lifestyle modifications with appropriate diet and exercises help to improve fertility and chances of pregnancy,” she shares, adding that meeting a preconception consultant and a diabetologist a few months before planning a baby can aid in a successful conception.
