Sugar Matters
October 9, 2009
Diabetes and Reproductive function

This week we will focus on reproductive function, meaning aspects of being able to conceive and produce a child. Given that the woman is the carrier of the baby and the keeper of the menstrual cycles, she often shoulders all the blame when no pregnancy results after some time trying to become pregnant.{{more}} After years of research we know that the “fault” can lie with either party (so for once and for all, STOP simply blaming the women). Actually 1/3 of the time the issue lies with the woman, 1/3 of the time it is the man, and truly the remaining 1/3 of the time has no cause that can be determined by available modern medicine.

In men, fertility is often less of a concern upfront. We hear mainly about how diabetes affects women and their reproduction, but rest assured, diabetes leaves its mark on men in this arena, too. While decrease in libido and erectile dysfunction are by far the most common complaints/symptoms, we have recently discovered that diabetes has molecular effects as well. Several research studies have shown that there is a small decrease in semen and sperm count in men with diabetes, especially those with insulin dependent diabetes. For some time there was argument if this actually made an impact on fertility, meaning the ability to fertilize a woman’s egg to produce a baby. Now we know that there is a higher chance of having chromosome problems in those sperm of men with diabetes, and this makes it more difficult to have a sperm function the way it should and thus more difficult to fertilize an egg that could go on to become a baby. We all know it becomes more difficult to conceive a child as we get older: chromosome damage is one of those reasons. Chromosomes are microscopic proteins that contain our genetic material, literally making us what we become. If they are damaged, sometimes the product cannot survive or nothing gets made at all. In men with diabetes these chromosome damages happen earlier and in higher numbers, so it becomes more difficult for those men to successfully fertilize a woman’s egg. I hope you are remembering your high school reproduction class for all this information I am throwing at you this week!

For women, diabetes has various effects. There are definite menstrual abnormalities associated with diabetes, both types 1 and 2, but in different ways. Variations in patterns of when the eggs are released can make it very difficult to become pregnant. Believe it or not, you can have periods but not have an actual fertile cycle. In addition, women with Type 1 diabetes are at increased risk of having premature menopause well before the average age of 50 when most women have menopause. In general, women with diabetes have more difficulty becoming pregnant, have higher rates of miscarriages, preterm deliveries, malformations in the baby, and complications during delivery than women without diabetes.

For all men and women with diabetes: it is in your best interest to get your diabetes under control before you plan on children. For their sake and yours. And if you are having difficulty conceiving a child, screening for diabetes or pre-diabetes is something you need to consider.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD
Medical Director Endocrine Care Group
Tel: 843-798-4227