Diabetes Mellitus: The Infertility Quadruple Threat

Posted on by Paul Turek, MD

Based on the feedback received from doctors reading the blog, we are introducing a new feature: Case of the Month. This Case of the Month features an actual patient from The Turek Clinic. Today’s case is presented to recognize American Diabetes Association Alert Day.

The Case of Male Infertility

He is a 31-year old who has been trying to conceive with his 28-year-old wife for two years. During this time, he has noticed a lower sex drive and has had trouble ejaculating. His medical history is unremarkable except for a six-year history of diabetes mellitus that is well controlled with insulin injections. Exacerbated, he stated, “I really don’t know what’s happening to me!”

Upon further questioning, the sex drive issue started even before they were trying to conceive. Regarding ejaculation, the patient states that his erections are not very strong and, although he has the sensation of climax, nothing comes out of the penis with ejaculation. In fact, he is concerned that things might be “backing up” in his body with these symptoms.

A Short Review of Diabetes

First identified as a disease of “sweet urine” in ancient times, diabetes mellitus a metabolic disease characterized by high blood sugar (glucose) levels. It is one of the most common medical diseases in the U.S., affecting 37 million adults and children or about 10% of the population. Among those affected, about 15 million are people of reproductive age.

Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. When the blood glucose rises, say after eating food, insulin is released to decrease the glucose level. In patients with diabetes, there is low or no production of insulin and therefore blood sugar levels are elevated. The sugars spill into the urine, hence the term “sweet urine.” Diabetes is currently a chronic medical condition that is not curable.

Can Diabetes Cause Infertility?

You bet. Diabetes can contribute to male infertility in four ways:

  • Causing erectile dysfunction by affecting the health of small blood vessels and lowering testosterone levels
  • Lowering sex drive through decreased testosterone levels
  • Reducing ejaculate volume by affecting the small nerves that control ejaculation and lowering testosterone levels
  • Fragmenting DNA in sperm: with impaired ejaculation, sperm longer to “get out” of the system and therefore are “older” and have higher rates of DNA damage than normal. This property leads to impaired performance during egg fertilization and early embryo development.

Indeed, this patient had all these issues simultaneously. Fortunately, many of these symptoms are fairly easy to correct with oral medications:

  • Erectile dysfunction: Viagra, Cialis or Levitra can restore erections
  • Sex drive and low testosterone: Selective estrogen receptor modulators (i.e. off label use of clomiphene citrate) can correct testosterone deficiency
  • Ejaculate volume: This is low because it is emptying backwards into the bladder instead of forward into the penis. This can be treated with over the counter cold medication (alpha agonists) to restore the normal direction of ejaculate flow.

Sure enough, with this combination of pills, the infertility “hat trick” induced by diabetes was overcome and the patient was able to conceive naturally after several months. Another family holiday card on its way to The Turek Clinic this year!

Remember that about 1/3 of infertility cases are due to the man. And diabetes is both a common and quite treatable cause of infertility. If you have diabetes and have had trouble conceiving, failing to address these issues is likely to impede your progress. So, do yourself and your future family a favor and take the Diabetes Risk Test today.