Because of the paucity of studies and inconsistencies regarding the impact of diabetes mellitus (DM) on semen quality, this disease is seldom looked for in the infertile patient. Recently, this view has been challenged by findings showing that DM induces subtle molecular changes that are important for sperm quality and function. This brief review shows the main sperm parameters in patients with DM and presents the mechanisms hypothesized to explain the changes observed in these patients. The data available suggest that DM alters conventional sperm parameters. In addition, DM causes histologic damage of the epididymis, with a negative impact on sperm transit. Various mechanisms may explain the sperm damage observed in patients with DM. These include endocrine disorders, neuropathy, and increased oxidative stress. Many authors suggest that DM decreases serum testosterone levels. This is associated with a steroidogenetic defect in Leydig cells. In addition, diabetic neuropathy seems to cause atonia of seminal vesicles, bladder, and urethra. Furthermore, DM is associated with an increased oxidative stress, which damages sperm nuclear and mitochondrial DNA. Finally, spermatogenesis derangement and germ cell apoptosis in type 1 DM may relate to a local autoimmune damage, whereas insulin resistance, obesity, and other related comorbidities may impair sperm parameters and decrease testosterone serum levels in patients with type 2 DM.Key words: Fertility, hormone, infertility, semen analysis.
J Androl 2012;33:145-153A lthough diabetes mellitus (DM) is known to cause many systemic complications, male infertility, based on impotence, retrograde ejaculation, and hypogonadism, is not widely recognized to be one of them. Because of the paucity of studies and inconsistencies regarding the impact of DM on semen quality, this disease is seldom looked for in the infertile patient. Recently, this view has been challenged by findings showing that DM induces subtle molecular changes that are important for sperm quality and function . In a retrospective analysis, we found a very high prevalence of subfertility (51%) among patients with diabetes (La Vignera et al, 2009a). Another study carried out in more than 500 male partners of infertile couples showed a prevalence of DM of <1.2% (Delfino et al, 2007). In a recent study, the prevalence of infertility in type 2 DM men was 35.1%. The prevalence of primary (16%) and secondary (19.1%) infertility was significantly higher in patients with diabetes compared with patients without diabetes. In addition, secondary infertility was higher than primary infertility. About half of the infertile men with diabetes were overweight, and 29.1% of them were obese. The smoking habit was more common in infertile men with diabetes (45.6%) than in fertile men with diabetes (33.6%). Statistical analysis confirmed that age, smoking habits, and obesity were the significant major contributors for infertility in men with diabetes. Obesity was the leading contributor for infertility. Other comorbid fa...