The Link Between Prediabetes and Male Infertility
Rates of diabetes and prediabetes have continued to rise with the escalating rates of obesity. Prediabetes is believed to be largely under-diagnosed among both men and women, mostly because there may be no symptoms for quite some time, and it requires a blood test to officially diagnose the condition. Researchers already know that diabetes can affect male fertility. A 2018 study aimed to see if prediabetes also has male fertility implications.
The study, published in BJU International used the American Diabetes Association (ADA) guidelines for prediabetes which suggests a fasting plasma glucose level of 100-125mg/dL or a two-hour oral glucose test result of 140 – 199 mg/dL, or an HbA1c of 5.7 – 6.4 percent. The cohort study involved 744 men who were already diagnosed with some form of primary infertility. Infertility issues can include fewer than normal amounts of sperm, sperm with motility issues or poor chromatin quality, or DNA fragmentation issues in sperm. Having one or more of these issues can largely impact the ability to impregnate a woman.
The researchers found that 15 percent of the subjects who had primary infertility also had undetected prediabetes – which had remained undiagnosed until blood tests were done during the research. In terms of their infertility issues, these men with diabetes had:
- Follicle stimulating hormone (FSH) levels that were lower than in healthy males
- Estradiol (E2) levels that were lower compared to healthy males
- Total testosterone levels lower than in healthy males
- Sex-hormone-binding globulin lower than in healthy males
The researchers did note that sperm concentration and semen volume in these men were similar to levels found in healthy men who did not have prediabetes. But the subjects with prediabetes had DNA fragmentation over a threshold of 30 percent – in fact as high as 58.4 percent versus a more normal median of 41 percent in healthy men without prediabetes. Hyperinsulinemia has been associated with androgen deficiency.
The lead researcher of the study, Luca Boeri, suggests that the findings in this first study to look at a link between male infertility and the presence of prediabetes were not surprising. Having consistent blood sugar elevations, based on diabetes studies, would be expected to impact male fertility. However, glycemic level increases did not appear to affect volume, count, motility, or morphology of sperm. This inconsistent finding, he suggests might be explained by the adaptive nature of the testes which seem to be able to adjust function to blood sugar elevations.
Boeri recommends that males who present with infertility issues should be evaluated for a possible diagnosis of prediabetes (or diabetes). Countermeasures that are taken may help to resolve the blood sugar abnormalities and the male infertility issues.
Health experts regularly recommend that women considering pregnancy evaluate their weight and lifestyle, to optimize the chances of getting pregnant and to ensure that they have a healthy pregnancy. This approach also helps to limit possible health issues in the child.
It’s not unreasonable to suggest that men also “get their house in order” and optimize their fertility and the likelihood of contributing healthy sperm. The following are some general recommendations for men who may be considering having children:
- Get a full physical including a complete metabolic panel
- Make sure you lose excess weight
- Eat a balanced diet that includes healthy fats, adequate protein and unprocessed carbohydrates
- Exercise regularly
- Make sure you get enough sleep daily
- Limit stress which can raise cortisol and instigate general inflammation
- Discuss family health history issues that might contribute to infertility
- Discuss any exposures (environmental, radiation) that might affect sperm count or quality
- Review any medications you are taking that might impact sperm health
There are also other ways to optimize your sexual health. It is reassuring to know that if you are diagnosed with prediabetes or diabetes, and have infertility issues, it is more than likely that if you modify your lifestyle, you can reverse the high blood sugar and also possibly reverse or at minimum improve the infertility issues. An earlier diagnosis and lifestyle intervention would likely lead to the best outcome.
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