DIABETES AND INFERTILITY (PART 1)

Diabetes has increased across the globe, with over 460 million people living with diabetes and about 4.2 million people died from this disease as at 2020. It is estimated that by 2045, over 700 million people will have the condition. Diabetes has also accounted for infertility both in male and female. Diabetes doubles a person’s risk to early death.

While the information above may seem threatening because of the very high burden of diabetes, this week’s topic is intended to resolve some vital mind bugging questions like:

What is Diabetes and how can one know he/she is diabetic?

What are the causes of diabetes?

How can diabetes affect males and female fertility?

What is pregnancy induced diabetes and how can it be managed?

Management and prevention of Diabetes Mellitus (DM) commonly referred to as Diabetes is a group of metabolic disorders in which there are high blood sugar level over a prolonged period.

What are the symptoms of high blood sugar?

Frequent urination.

Increased thirst.

Increased hunger.

Diabetes if left untreated may result in acute complications like;

Diabetic ketoacidosis (a condition where the body produces too much acid which may lead to coma).

Hyperosmolar hyperglycaemia.

Death.

Effects of Diabetes on other organs includes

Cardiovascular (heart) disease.

Stroke.

Chronic kidney disease.

Foot ulcer.

Damage to the eyes.

Cause of Diabetes Mellitus

The organ called the pancreas is responsible for producing insulin, a hormone that makes it possible for the cells of the body to utilize the sugar gotten from the foods consumed.

DM may occur due to insufficient Insulin production.

DM may also be due to the cells of the body not responding properly to the insulin produced.

Types of Diabetes Mellitus (DM)

Type 1 DM- occurs due to failure of the Pancreas to produce enough Insulin. This form of DM is also referred to as Insulin Dependent Diabetes Mellitus (IDDM) or Juvenile diabetes its cause is unknown.

Type 2 DM- begins with insulin resistance, a condition in which the cells fail to respond to insulin properly. As the condition progresses a lack of insulin may develop. The most common cause is excessive body weight and physical inactivity, unhealthy diet, excessive alcohol and tobacco consumption.

Gestational DM- this occurs when a pregnant woman with no previous history of diabetes develop high blood sugar level.

Effect of Diabetes Mellitus on Fertility

Infertility as defined by World Health Organization (WHO) is the inability to conceive an offspring. Depending on the age of the individual, if less than 35 years, one year of unprotected timed intercourse, if over 35 years only six months of unprotected timed intercourse before being labelled as infertile. Timed intercourse means the intercourse at the ovulation of the egg of the female.

Effect of Diabetes on Fertility of Males

Men can suffer erectile dysfunction or difficult erection of the penis, delayed ejaculation and reduced sperm quantity and even reduced testosterone (or sexual desire). Men that suffer infertility from Diabetes, their erection difficulties are caused by nerve damage and slower circulation in the small blood vessels due to poorly controlled diabetes.

When the nerves of the male organ, the penis, are damaged, there is lack of sensitivity and the ability to ejaculate or eject, the sperm is also impaired and in some cases there is delayed emission of the sperm. Backwards or retrograde ejaculation occurs from damage of the nerves of the penis when the bladder remains open during ejaculation and the sperm enters the bladder instead of exiting normally from the penis. This backwards movement of the sperm would delay the fertilization of the awaiting egg thereby causing infertility of the male partner.

Various research studies on the effect of Diabetes have revealed a reduced sperm quality, therefore reducing the male fertility.

Diabetes also lowers levels of the male hormone, testosterone, which leads to low sperm count and reduced libido (sex drive).

Effect of Diabetes on Fertility of Females

Polycystic Ovarian Syndrome (PCOS).

OIigomenorrhea (Irregular periods).

Secondary Amenorrhea (period that stop and restart).

Premature menopause (complete arrest of periods earlier than usual).

Diabetes can cause pregnancy to be a nightmare with Gestational Diabetes.

Polycystic Ovarian Syndrome (PCOS), previously presented in This Day health column, deals with women that have multiple cysts in the ovaries leading to missed periods and infertility. There is a close association with obesity and Diabetes. Studies have shown that females with Type 1 (Childhood) and Type 2 (Adult onset) Diabetes is prone to Polycystic ovarian syndrome (PCOS).

Women with Diabetes have disorganized cycles of period in the form of missed periods (OIigomenorrhea) and even long intervals of no periods (secondary amenorrhea). This is as a result of the pituitary gland hormones losing its control of the reproductive organs.

Management

Most of these infertility issues can be handled with ease through Assisted Reproductive Technology (ART), using In Vitro Fertilization (IVF) techniques. At times, consultation with an urologist and use of special surgical techniques, TESA, are necessary to ensure delivery of a single normal and viable sperm to the awaiting egg.

Close collaboration with your fertility specialist will help with the understanding of the proper medications and lifestyle change needed to be at the peak of Reproductive health even in Diabetics……………………………………..………….TO BE CONTINUED