Male infertility associated with diabetes has a solution
Male infertility associated with diabetes has a solution
Almost 300,000 Spaniards suffer from some type of diabetes, a disease that has a negative impact on the fertility of men and women. With current knowledge, infertility associated with DM (Diabetes Mellitus) has a solution in most cases.
The impact of DM on male fertility has an even more variable clinical picture compared to female fertility. Symptoms include erection problems, a lack of libido, insufficient secretion of male sex hormones (androgens), retrograde ejaculation (redirection of the fluid that is going to be ejaculated into the bladder) and damage (fragmentation) in the DNA of the sperm
As in the case of female infertility, early diagnosis and personalized therapy are the solutions of first choice and may be sufficient. If not, other therapies can come into play, such as oral medication with Viagra or Cialis for erection problems, replacement therapy with testosterone in cases of sexual hormone insufficiency, in vitro fertilization with sperm recovered from urine in cases of retrograde ejaculation or an oral treatment with antioxidants to reduce DNA fragmentation of sperm.
"An early diagnosis of DM, even before the onset of clinical symptoms, is important to develop a tailored therapeutic plan for each patient," explains Dr. Jan Tesarik, expert in human fertility. A plan that must take into account the type of DM, if it is in the future father or the future mother, the age of both parents and the possible coexistence of other associated pathologies. In addition, adequate supervision during pregnancy and after delivery is necessary to minimize the risk of health problems in the offspring.
(Photo: MARGEN)
According to Tesarik "in the not too distant future, research related to the genetic and epigenetic mechanisms of DM will allow a refinement of diagnostic and therapeutic methods to further increase the effectiveness of infertility treatments associated with DM."
The impact on fertility is different for patients with T1DM or T2DM. Diabetes mellitus (DM) is a disease characterized by an excess of glucose in the blood. The cause of type 1 DM (DMT1), also known as insulin-dependent, is the insufficiency of the production of the hormone insulin by the islets of Langerhans of the pancreas. In type 2 DM (DMT2), called noninsulin-dependent, the problem is not the production of insulin but the ability of the target cells to respond to their action to use glucose. More than 400 million people worldwide (about 300 thousand in Spain) suffer from some type of DM, 10-15% of them DMT1 and 85-90% DMT2.
For more than 20 years sporadic observations have been published that point to different health risks for children whose parents suffer some type of DM. The transmission of DM from parents to children is more likely in cases of T2DM, especially if the mother suffers. Direct transmission of DMT1 is rare. It is assumed that DMT1 develops more frequently in people who have inherited risk factors, both genetic and nongenetic (epigenetic) of both parents. Some mitochondrial DNA anomalies, only transmissible by the mother, can cause DM in future generations. An article published this year in the Journal of the American Medical Association also links the presence of DM of both types in the mother with an increased risk of autism in the offspring.
According to an article published 1 year ago in Scientific Reports, the "open access" journal of the Nature group, the greatest risks to children's health seem to be associated with epigenetic problems, related to anomalies in the genetic imprinting of sperm in men. with the DM. In the latest issue of the Journal of Gynecology and Women's Health, a Franco-Spanish group of researchers and physicians publishes observations suggesting that DNA released from testicular cells relates this type of hidden defects of the process of formation of the sperm Dr. Jan Tesarik, one of the authors of this publication and the director of the MARGen Clinic of Granada, comments: "There are methods that can help determine the cellular origin of free DNA and thus clarify the origin of the pathology. Throughout the formation of sperm from its precursor cells important changes occur in certain genes, known under the name of epigenetic evolution. These processes do not alter the sequence of the genes themselves, but they add non-hereditary factors that determine at what point the gene will be active or repressed in different cell types. In each sperm, the set of these phenomena, called genetic imprinting, is important so that the embryo, which results from fertilization with the sperm, can develop normally. Abnormalities of genetic imprinting generally do not prevent fertilization, but cause implantation failures, spontaneous abortions or abnormalities of the children born. The analysis of the imprint in the free DNA from the testicles will give us information about eventual risks of this type. In the case of men with DM, this analysis will allow us to evaluate the effects of different therapeutic processes used on the epigenetic state of their sperm and adapt these processes to minimize the risks of the transmission of anomalies of this type to future generations. "
Diabetes insipidus is a disease 200,000 times less frequent than DM and rarely affects male fertility. It occurs in 1 in 25,000 people and is characterized by persistent polyuria and thirst. It can be of renal origin (inability of the kidneys to retain water and its excessive release to the urine) or pituitary (insufficiency or poor function of the hormone that regulates the absorption of water in the kidneys). Both types of diabetes insipidus are often associated with other abnormalities of the responsible organs, kidneys and pituitary respectively. Its detection is part of the overall diagnosis of infertility. Depending on the results, different treatments can be used.
"An early diagnosis of DM, even before the onset of clinical symptoms, is important to develop a tailored therapeutic plan for each patient," explains Dr. Jan Tesarik, expert in human fertility. A plan that must take into account the type of DM, if it is in the future father or the future mother, the age of both parents and the possible coexistence of other associated pathologies. In addition, adequate supervision during pregnancy and after delivery is necessary to minimize the risk of complications of pregnancy, health problems in the offspring and the development of a postpartum DM in women diagnosed with gestational DM.
According to Tesarik "in the not too distant future, the investigations related to the genetic and epigenetic mechanisms of the DM will allow a refinement of the diagnostic and therapeutic methods to increase the effectiveness of the current treatments of the infertility associated with the DM". (Source: MARGEN)
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