Understanding Male & Female Fertility Linking Diabetes

Author: Dr. Jasneet Kaur, Consultant and Clinical Director – Reproductive Medicine, Milann Fertility Center, Chandigarh

India

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Chandigarh, April 04, 2025;

When we talk about diabetes, the first associated disease comes in mind are heart disease, nerve damage, and kidney issues, and its impact on fertility is frequently overlooked. What is Diabetes? “Diabetes” is a chronic medical condition characterized by high blood sugar levels due to the body’s inability to make enough insulin or because the body’s cells are resistant to insulin.

In recent years, there has been a rise of diabetes cases worldwide, its effects on reproductive health are becoming a growing concern. Both men and women with diabetes face unique challenges when trying to conceive. While diabetes does not make pregnancy impossible, it can contribute to hormonal imbalances, which can disrupt the physiological processes of producing and carrying eggs or sperm. These disruptions can lead to sperm dysfunction, or embryo implantation, etc.

Symptoms & Types of Diabetes

Here symptoms include increased thirst, exhaustion, frequent urination, and unexplained weight loss.  Diabetes comes in three different forms:

l In type 1 diabetes, body is unable to generate insulin, hence, injections are essential for survival.

l The most prevalent is type 2 diabetes, which affects blood sugar levels and many other body processes because the body does not use insulin effectively.  Therefore, appropriate management and regulation are required.

l Gestational diabetes arises when the body is unable to produce enough insulin to meet the growing demands during pregnancy.   It usually goes away after birth and has no long-term effects on fertility.

Impact of Diabetes on 

1. Female Fertility
2. Hormonal Imbalance and Irregular Ovulation

Insulin resistance, which throws off the hormonal balance, is common in women with diabetes, especially type 2.  Anovulation, or irregular ovulation, is caused by elevated testosterone levels brought on by insulin resistance.  This is frequently observed in women who have PCOS, a fertility-affecting disorder that is closely associated with diabetes.  A person’s physical and mental sensations can also be affected by blood sugar levels, both high and low.  Compared to people without diabetes, men and women with diabetes are more likely to have low libido, especially if their diabetes is poorly managed.  Reduced frequency of sexual activity is linked to lack of desire, and this can make it harder to conceive.

2. Increased Risk of Miscarriage and Pregnancy Complications

Uncontrolled diabetes increases the risk of complications such as gestational diabetes and preeclampsia, as well as miscarriage.  The uterine lining is harmed by high blood sugar, which reduces its receptiveness to implantation.  Furthermore, uncontrolled diabetes can result in pregnancy difficulties and birth abnormalities, making preconception care even more crucial.

3. Impact on Egg Quality

Ovarian reserve and egg quality may be impacted by prolonged exposure to elevated blood sugar levels.  Diabetes-induced oxidative stress may hasten ovarian ageing, decreasing the likelihood of conception and raising the risk of chromosomal abnormalities in developing embryos, according to studies.

1. Male Fertility
2. Reduced Sperm Quality and DNA Damage

Men with diabetes frequently exhibit greater DNA fragmentation, decreased motility, and fewer sperm.  Oxidative stress brought on by high blood sugar damages sperm DNA and lowers the likelihood of successful fertilisation.  The risk of miscarriage and unsuccessful IVF or ICSI cycles is also increased by poor sperm health.

2. Erectile Dysfunction and Low Testosterone Levels

Diabetes can cause erectile dysfunction (ED) by impairing blood circulation and causing neuropathy, or damage to the nerves.  Lower testosterone levels are another effect of diabetes on the hypothalamic-pituitary-gonadal axis.  Less libido and poorer sperm production are the outcomes of this hormonal imbalance.

3. Retrograde Ejaculation

Semen may enter the bladder rather than exiting through the urethra in certain men with chronic diabetes, a condition known as retrograde ejaculation.  This results from nerve injury that affects the ejaculatory muscles, which causes infertility.

Managing Diabetes for Better Fertility Outcomes

But to surprise, diabetes-related infertility can often be improved with lifestyle changes and medical intervention, such as:

l First and foremost important managing blood sugar levels. Women should aim for an HbA1c level below 6.5% before trying to conceive, while men should focus on stable glucose levels to prevent sperm damage.

l Reproductive health and insulin regulation are enhanced by a diet high in fibre, whole grains, lean meats, and healthy fats.

l Regular physical activity enhances insulin sensitivity, supports weight management, and improves hormonal balance which further is effective for managing diabetes and boosting fertility.

l Men with low testosterone or sperm abnormalities and women with PCOS or irregular ovulation should see a specialist for fertility aid. Hormone therapy and assisted reproductive technologies (ART) like IVF and ICSI can help couples with infertility caused by diabetes.

To put it briefly, diabetes can be controlled by leading a healthy lifestyle and controlling blood sugar levels.  Additionally, the likelihood of becoming pregnant and having a good pregnancy might aid with the transition to motherhood.