Diabetes is a growing epidemic in the world. Diabetes Mellitus can have a significant impact on male reproductive health and contribute to a decline in global birth rates. A systematic review has shown that hyperglycemia can impair testosterone secretion and sperm quality, leading to male infertility.

Insulin-dependent diabetes is characterized by the failure to produce sufficient amounts of insulin after repeated exposure to insulin. The presence of elevated blood sugar levels can cause issues with testosterone production and function in men with both forms of diabetes, according to some studies.

Beyond its direct impact on testicular function and spermatogenesis, diabetes can also negatively impact male fertility through several other mechanisms as well. Here we will discuss these additional effects of diabetes on male fertility, their causes, and how they might be treated or mitigated.

Hyperglycemia and impairment to fertility

Insulin is a hormone that regulates the metabolism of carbohydrates in the body. It is produced in the pancreas and plays an important role in the transfer of nutrients from the blood stream to cells, including sperm cells in the testes.

Insulin resistance is a condition in which cells do not respond normally to insulin and glucose levels increase in the blood stream known as hyperglycemia.

Glucose metabolism is an important step in spermatogenesis. Studies have shown that hyperglycemia can lead to a loss of pancreatic beta-cells or a decline in their function, resulting in decreased insulin secretion. In a man with hyperglycemia, the increased glucose in the blood may impair the production and function of male reproductive hormones, including testosterone. Insulin resistance is common in men with type-2 diabetes, and it is also possible that some men with diabetes may have insulin-independent diabetes, in which the pancreas produces insulin, but it is not absorbed by the cells as it should be.

DNA damage is caused by reactive oxygen species, which are generated during high levels of oxidative stress. Oxidative stress is a biochemical imbalance caused by an excess of free radicals, which are unstable molecules that can damage cellular membranes and DNA. High levels of oxidative stress have been shown to impair the ability of sperm to fertilize an egg and increase the risk of fertilized egg loss and an unsuccessful pregnancy.

Diabetes has also been shown to negatively influence fertility in men through reduced sperm motility and increased sperm DNA damage. Sperm motility refers to the ability of sperm to move and swim, which is essential for fertilization. If sperm do not move, there is no chance that an egg will be fertilized by them. In men with decreased motility, sperm are unable to swim and are therefore less likely to fertilize the egg.

Thus, Diabetes Mellitus can lead to decreased fertility in men via decreased sperm motility and morphology, increased sperm DNA damage and reduced fertilization and pregnancy success. In addition, high blood sugar levels impair the function of sperm, thus reducing their ability to fertilize an egg and increasing the risk of blocked or abnormal sperm morphology.

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