Almost 300,000 Spaniards suffer from some type of diabetes, a disease that has a negative impact on the fertility of men and women. With current knowledge, infertility associated with DM (Diabetes Mellitus) has a solution in most cases.
The impact of DM on male fertility has an even more variable clinical picture compared to female fertility. Symptoms include erection problems, a lack of libido, insufficient secretion of male sex hormones (androgens), retrograde ejaculation (redirection of the fluid to be ejaculated into the bladder), and damage (fragmentation) in the DNA of sperm.
As is the case with female infertility, early diagnosis and personalized therapy are the first-choice solutions and may be sufficient. If not, other therapies may come into play, such as oral medication with Viagra or Cialis for erection problems, testosterone replacement therapy in cases of insufficient sex hormones, in vitro fertilization with sperm recovered from the urine in cases of retrograde ejaculation, or oral antioxidant treatment to reduce sperm DNA fragmentation.
Jan Tesarik, an expert in human fertility. A plan that you should have in mind takes into account the type of DM, whether it is found in the future father or the future mother, the age of both parents, and the possible coexistence of other associated pathologies. In addition, adequate supervision is necessary during pregnancy and after childbirth to minimize the risk of health problems in the offspring.
According to Tesarik “in the not too distant future, research related to the genetic and epigenetic mechanisms of DM will allow a refinement of diagnostic and therapeutic methods to further increase the efficacy of treatments for infertility associated with DM”.
The impact on fertility is different for patients with DMT1 or DMT2. Diabetes mellitus (DM) is a disease characterized by an excess of glucose in the blood. The cause of type 1 DM (T1DM), also known as insulin-dependent, is insufficient production of the hormone insulin by the islets of Langerhans in the pancreas. In type 2 DM (T2DM), called non-insulin-dependent, the problem does not lie in the production of insulin but in the ability of the target cells to respond to its action to use glucose. More than 400 million people around the world (about 300 thousand in Spain) suffer from some type of DM, 10-15% of them T1DM, and 85-90% T2DM.
Sporadic observations have been published for more than 20 years that point to different health risks for children whose parents suffer from some type of DM. Transmission of DM from parents to children is more likely in cases of T2DM, especially if the mother has it. Direct transmission of DMT1 is rare. T1DM is supposed to develop more often in people who have inherited risk factors, both genetic and non-genetic (epigenetic) from both parents. Some mitochondrial DNA abnormalities, only transmissible from the mother, can cause DM in future generations. An article published this year in the Journal of the American Medical Association also links the presence of both types of DM in the mother with an increased risk of autism in the offspring.
According to an article published 1 year ago in Scientific Reports, the journal “open access” of the Nature group, the greatest risks to the health of children seem to be associated with epigenetic problems, related to abnormalities in the genetic imprint of men’s sperm with the DM. In the latest issue of the Journal of Gynecology and Women’s Health, a French-Spanish group of researchers and doctors publishes observations that suggest that the DNA released from testicular cells reports this type of hidden defects in the process of the formation of testicular cells. sperm. Dr. Jan Tesarik, one of the authors of this publication and the director of the MARGen Clinic in Granada, comments: “There are methods that can help determine the cellular origin of free DNA and thus clarify the origin of the pathology. Throughout the formation of sperm from their precursor cells, important changes occur in certain genes, known under the name of epigenetic evolution. These processes do not alter the sequence of genes themselves, but additional factors, not inherited, that determine at what point the gene will be active or repressed in different types of cells. In each sperm, the set of these phenomena, called genetic imprinting, is important so that the embryo, which results from fertilization with the sperm, can develop normally. Abnormalities of the genetic imprint generally do not prevent fertilization but cause implantation failures, miscarriages, or abnormalities of the children born. The analysis of the imprint on the free DNA from the testicles will give us information on possible risks of this type. In the case of men with DM, this analysis will allow us to evaluate the effects of different therapeutic processes used on the epigenetic status of their sperm and adapt these processes to minimize the risks of transmitting abnormalities of this type to future ones. generations ”. Diabetes insipidus is a disease 200,000 times less common than DM and rarely affects male fertility. It occurs in 1 in 25,000 people and is characterized by persistent thirst and polyuria. It can be of renal origin (inability of the kidneys to retain water and its excessive release into the urine) or pituitary (failure or poor function of the hormone that regulates the absorption of water in the kidneys). Both types of diabetes insipidus are often associated with other abnormalities of the responsible organs, kidneys, and pituitary respectively. Its detection is part of the global diagnosis of infertility. Depending on the results, different treatments can be used. A plan that must take into account the type of DM, if it is found in the future father or future mother, the age of both parents, and the possible coexistence of other associated pathologies. In addition, adequate supervision is necessary during pregnancy and after delivery to minimize the risk of pregnancy complications, health problems in the offspring, and the development of postpartum DM in women diagnosed with gestational DM. According to Tesarik “in the not too distant future, research related to the genetic and epigenetic mechanisms of DM will allow a refinement of diagnostic and therapeutic methods to increase the efficacy of current treatments of infertility associated with DM”.