Diabetes is a chronic health condition that affects millions of people worldwide, and its complications go far beyond the well-known issues like heart disease and kidney failure. One lesser-known but critical consequence is its potential impact on male fertility. Research has increasingly shown that diabetes can contribute to infertility in men, affecting their ability to conceive with a partner. We got in touch with Dr Smeet Patel, Gynaecologist and Endometriosis Specialist, Mayflower Women’s Hospital, Ahmedabad who explains the connection between diabetes and male infertility, shedding light on how this condition can affect reproductive health and what men can do to mitigate these effects.

Dr Smeet shares, infertility is commonly defined as the inability of a couple to conceive after one year of regular, unprotected intercourse. While infertility is often considered a female issue, it affects men and women nearly equally. Studies suggest that approximately 10 to 20 per cent of couples worldwide struggle with infertility, with about 10 per cent of men having issues related to sperm production or health.

Male infertility can stem from various factors, including problems with sperm count, motility (movement), or morphology (shape). Diabetes, both Type 1 and Type 2, has been found to have a significant impact on these factors, directly affecting a man’s reproductive capabilities.

How Diabetes Impacts Male Fertility

1. Sperm Quality and DNA Fragmentation

One of the primary ways diabetes affects male fertility is through damage to sperm quality. Dr Smeet shares that diabetic men tend to have a higher percentage of sperm with nuclear and mitochondrial DNA fragmentation. Studies have shown that sperm from diabetic men are more likely to have structural abnormalities that make it difficult to fertilize an egg. This damage is largely oxidative, meaning that high blood sugar levels cause oxidative stress that damages the DNA in sperm.

Sperm DNA damage is closely linked with poor embryo quality, lower implantation rates, and potentially the early onset of certain childhood diseases. Further, sperm with compromised DNA can lead to miscarriage or the failure of assisted reproductive techniques like IVF.

Glucose metabolism plays a crucial role in spermatogenesis—the process by which sperm is produced in the testicles. Diabetes interferes with this process, affecting sperm production, motility, and overall health. Dr Smeet shares that proper glucose levels are essential not just for the production of sperm but also for maintaining their motility, which is necessary for successful fertilization.

Both Type 1 and Type 2 diabetes have been shown to disrupt these processes, leading to lower sperm counts and less healthy sperm. Furthermore, diabetic men often face issues with seminal plasma composition, which can impair the ability of sperm to function properly and reach the egg.

3. Hormonal Imbalances and Obesity

Another crucial factor linking diabetes and infertility is hormonal imbalance, often exacerbated by obesity. Dr Smeet explains many men with diabetes also suffer from obesity, which can lead to a condition known as hypogonadotropic hypogonadism. This is a hormonal imbalance where the body does not produce enough testosterone, a hormone essential for sperm production. Obesity in men can lead to lower levels of total testosterone and free testosterone, which further impairs fertility.

In addition, metabolic syndrome and conditions like sleep apnea—often associated with both obesity and diabetes—further complicate this issue by contributing to a state of hormonal imbalance that negatively affects reproductive health.

Emerging research suggests that diabetes may have long-lasting effects on male fertility through epigenetic changes. “These are alterations in gene expression that do not involve changes to the DNA sequence itself but can be passed onto offspring. Diabetes can cause epigenetic modifications during spermatogenesis, and these changes could potentially impact future generations,” he said.

“For example, studies have shown that diabetes can increase the risk of passing on metabolic disorders to offspring. Diabetic fathers may unknowingly pass on an increased risk of diabetes and related health conditions through these epigenetic changes. This highlights the importance of managing diabetes not only for one's health but also for the health of future generations,” he further added.

Despite the complications diabetes can cause, there are steps men can take to reduce its impact on fertility. Dr Smeet shares that weight loss and lifestyle changes are among the most recommended actions. For men who are overweight or obese, losing weight can improve hormonal balance, reduce insulin resistance, and enhance overall sperm quality.

Managing blood sugar levels through proper diet, regular exercise, and medications is also essential. Keeping blood sugar levels within a healthy range can significantly reduce the oxidative stress on sperm and improve the chances of conception. In cases where diabetes has caused severe sperm damage, assisted reproductive technologies (ART) such as IVF or ICSI (intracytoplasmic sperm injection) may be necessary.

“Men with diabetes can improve their fertility outcomes. For those struggling with infertility, it’s essential to seek medical advice to explore all possible treatments and make informed decisions about their reproductive health,” he said.

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