Wednesday, 20 June 2018


Research has shown that once a couple passes twelve months of trying to conceive with no success, and that means sex without use of contraception 3 times a week or more, the couple is deemed infertile. 

One of the first medical conditions checked by the doctor during routine checkups is diabetes, since this can cause fertility problems in both sexes. 

Even when conception takes place inspite of diabetes, poor control of blood sugar can lead to recurrent miscarriages. This occurs due to the toxicity of high blood sugar levels to the developing embryo. 

Diabetes: A short review 

First identified as disease of “sweet urine” in ancient times, diabetes mellitus is a metabolic disease characterized by high blood sugar (glucose) levels. 

Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. When the blood glucose level rises, insulin is released to decrease the glucose level. In patients with diabetes, there is low or no production of insulin resulting to elevated blood sugar levels. The sugars spill into the urine, hence the term “sweet urine”. 

Diabetes and fertility in men 

Diabetes can negatively impact fertility in the following ways: 

· Erectile dysfunction 

· Ejaculatory dysfunction 

· Hypogonadism and semen abnormalities 

1. Erectile dysfunction : Impotence or erectile dysfunction is the inability to achieve and maintain an erection long enough to achieve sexual satisfaction. This condition makes conception difficult. 

Diabetes is a well known risk factor for developing erectile dysfunction. 

Diabetes affects the nerves and blood vessels throughout the body, including those that supply the penis. 

Damage to the nerves can cause decreased sensation and arousal, while the decreased blood flow to the penis can lead to difficulty achieving or maintaining erections firm enough for satisfactory sexual encounters.(Arrellano, et al) 

Medications help relax the smooth muscle in the penis, thereby increasing the flow of blood and allowing for erections. 

2. Ejaculatory dysfunction: This is another problem encountered among men with diabetes. Normal ejaculation is essential to allow for deposition of semen into the female reproductive tract, where the sperm can fertilize the female egg. Damage to the nerves from long standing diabetes can cause a failure of the mechanism that propels sperm forward. This can allow the sperm to go backwards into the bladder rather than out through the penis, this is called “retrograde ejaculation”. In some cases, there is complete absence of ejaculation, known as “anejaculation”.(Gaunay et al) 

Treatments for retrograde ejaculation consist of medications that prevent semen from going backwards into the bladder during ejaculation. Sometimes, semen can be extracted from the bladder after ejaculation for either artificial insemination or in-vitro fertilization. Sperm quality can be optimized by increasing the pH of the urine with sodium bicarbonate or other agents. 

3. Hypogonadism and semen abnormalities: Diabetic men have shown to have a higher chance of abnormalities within the sperm such as decreased number of sperm per ejaculate, decreased motility, increased number in abnormal sperm shape and a decrease in sperm DNA integrity. However, abnormalities such as low testosterone, which are common in diabetic men may also affect libido or worsen erectile dysfunction.(Paul Turek, 2012) 

Diabetes and fertility in women 

Diabetes type 1 and 2 should be considered in the differential diagnosis of menstrual abnormalities and infertility in women. The reproductive period of diabetic women may be reduced due to delayed menarche and premature menopause. During the reproductive years, diabetes has been associated with menstrual abnormalities, such as oligomenorrhea and secondary amenorrhea. 

Diabetes can affect fertility in many different ways in women. In women with type 1 diabetes, antibodies are produced that cause the woman’s body to attack the male’s sperm as well as her own egg. 

Some diabetic women have a condition underlying their sugar problems. This condition called Polycystic ovarian syndrome (PCOS). In this condition, too much testosterone is produced and this affects the ability of the eggs to mature within the ovaries. Because women with PCOS develop insulin resistance, there are often ovulatory problems leading to irregular periods. Because of the irregularity of their cycle, cysts develop, which are fluid-filled cavities within the ovaries. 

Overtime, all of these issues make the thought of pregnancy begin to seem more distant. 

However, insulin resistance can be controlled with diet, exercise, and drugs. Once conception is achieved, the challenge is to control blood sugar levels so that the pregnancy can be carried to term. Miscarriage is not the only issue that is derived from high blood sugar levels during pregnancy. 

Uncontrolled sugar may also lead to premature delivery as well as birth defects. Sometimes, high sugar level leads to overly large babies which carries the potentials of injuries to both mother and child during delivery. 

Women with persistent menstrual abnormalities despite adequate treatment need to be approached by broader evaluation. 

Please see your doctor or the nearest doctor close to your neighborhood for details!


Disclaimer: Comment expressed do not reflect the opinion of Isaac Yoma