Can Diabetes Cause Infertility?

According to the American Diabetes Association, diabetes is a disease that affects as many as 23 million Americans and presents a wide range of side effects if poorly managed. In addition to vascular and neurological issues that may lead to damaged internal organs, a related side effect can be infertility in both men and women. Diabetes and insulin-related infertility are, in fact, very common, according to Dr. Tommaso Falcone of the Cleveland Clinic's Department of Obstetrics and Gynecology.

• Poorly managed diabetes can cause infertility in both men and women.

Female Infertility

• According to Dr. Falcone, high levels of blood glucose can exacerbate the most common mechanism associated with female infertility: polycystic ovary syndrome (PCOS). PCOS is a condition associated with high levels of androgens (hormones most common in males) that result in irregular or missed periods and ovarian cysts. Such cysts interfere with the normal implantation of a fertilized egg, and missed periods reduce the likelihood of fertilization as well.

Erectile Dysfunction

• Three common causes of diabetes are related to erectile dysfunction. Poorly managed diabetes often causes damage to nerves and blood vessels, which can interfere with blood flow to the penis and thus the ability to achieve an erection. Similarly, cardiovascular disease associated with diabetes may narrow and harden blood vessels with the same result. The third common cause is high levels of blood glucose that can, over time, interfere with blood flow to the penis by reducing the production of nitric oxide.

Retrograde Ejaculation

• Nerve damage caused by diabetes may result in retrograde ejaculation. Normally, semen is ejected through the urethra when muscles that form the sphincter of the bladder contract. If nerve damage prevents these muscles from working properly, however, semen may be forced into the bladder rather than reaching the female reproductive system.

Damaged DNA

• Although it had been thought that the quality of sperm was unaffected by diabetes, in 2008 Dr. Con Mallidis at Queen's University, United Kingdom presented evidence that high levels of blood glucose associated with poorly managed diabetes results in the accumulation of advanced glycation end products (AGEs), which damage the DNA held within sperm. Fragmented or damaged DNA is, in turn, associated with both low implantation rates and high miscarriage rates.

Psychological Effects

• Diabetes-related infertility has psychological ramifications as well as physical. Depression is a common effect of infertility as both men and women may experience feelings of frustration, discouragement and disappointment. Depression can lead to lowered productivity at home and work, as well as fragmented professional and personal relationships.

Treatment

• Contact a health care professional familiar with diabetes and insulin-related infertility. The most common treatments are exercise and weight loss through the regulation of diet. A diabetic diet typically involves a combination of calorie restrictions to facilitate weight loss, lowered consumption of sugar and tracking of daily carbohydrate intake.