Type 1 diabetes mellitus and sperm quality: A case-control study

Andrea Delbarba; Valentina Anelli; Francesca Bambini; Caterina Buoso; Paolo Facondo; Elisa Gatta; Angela Girelli; Carlo Cappelli; Alberto Ferlin

doi:10.1111/andr.13681

Male Fertility · Male Factor Causes

Type 1 diabetes mellitus and sperm quality: A case-control study

Delbarba A, Anelli V, Bambini F, Buoso C, Facondo P, Gatta E, Girelli A, Cappelli C, Ferlin A

Published February 2025 Andrology

DOI 10.1111/andr.13681 PMID 38924386 PMC PMC11815542

RRM Academy Synopsis

Young men with type 1 diabetes had poorer semen quality than controls

Men aged 18 to 40 with type 1 diabetes had lower semen volume, sperm count and motility than age-matched controls. This Italian case-control study compared 42 men with diabetes and 43 without. In these groups, about 14 out of 100 men with diabetes reported couple infertility, against about 2 out of 100 controls.

Key Findings

Couple infertility was reported by 14.3% of men with type 1 diabetes and 2.3% of controls (p = 0.045). Paternity rates did not differ significantly (p = 0.111).
Semen volume, total sperm number, total motility and progressive motility were significantly lower with type 1 diabetes (p < 0.001, p = 0.003, p = 0.048 and p = 0.022 respectively).
Low semen volume (hypoposia) affected 15.4% of men with diabetes and 0% of controls (p = 0.008). Reduced sperm motility (asthenozoospermia) affected 33.3% and 11.6% (p = 0.018).
Anti-sperm antibodies were present in the semen of 38.4% of men with diabetes and 9.3% of controls (p = 0.003). Erectile dysfunction affected 23.8% and 6.9% (p = 0.031).
Semen analysis was available for 39 of the 42 men with diabetes, because 3 men (7%) had anejaculation, the inability to ejaculate.

Interpretation

A case-control study compares people who have a condition with similar people who do not, at one point in time. The design shows an association between type 1 diabetes and poorer semen results. Each group held about 40 men from one hospital in Brescia, Italy, and the men with diabetes had no overt complications of the disease. The authors list the small sample as a limit. Controls also lacked hormone tests, sperm culture and testicular ultrasound. The authors propose oxidative damage, infection of the semen and pelvic nerve changes as possible mechanisms and call for confirmation in a larger group.

RRM Context

Restorative reproductive medicine evaluates both partners. A long-term illness in the male partner, such as type 1 diabetes, belongs in the diagnostic picture. A semen analysis and a full medical history give the male evaluation its start. Infertility labeled unexplained is undiagnosed until the male partner has been checked as fully as the female partner.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

The potential impact of diabetes mellitus type 1 (DM1) on male fertility is currently poorly defined. Hyperglycaemia and insulin deficiency may affect spermatogenesis. Some evidence suggests that men with DM1 have a significant reduction in progressive sperm motility, sperm morphology and semen volume, without significant changes in sperm concentration and count, but definite data are lacking.

Objectives

To evaluate the impact of DM1 on clinical parameters related to male fertility and semen analysis.

Materials and Methods

We compared a court of 42 male DM1 patients with 43 nondiabetic subjects overlapping in age and remaining clinical data in an observational case-control study. All subjects underwent a comprehensive andrological reproductive evaluation, including medical history, physical examination, and semen analysis. We collected biochemical data in all patients with DM1, while diabetic patients with any alteration in semen parameters underwent sperm culture and scrotal ultrasound. In addition, all men completed the IIEF-5 questionnaire (International Index of Erectile Function-5) and the AMS (Aging Male Symptom score) questionnaire.

Results

Patients with DM1 had a higher prevalence of infertility, erectile dysfunction and worse semen parameters compared with controls. In particular, semen volume, total sperm count, and total and progressive sperm motility were significantly lower (p < 0.001, p = 0.003, p = 0.048, and p = 0.022 respectively). In addition, the rate of semen anti-sperm antibody positivity, the AMS score and FSH levels were higher.

Discussion and Conclusions

Several mechanisms may contribute to these semen alterations in DM1 patients, such as oxidative damage to spermatogenesis, seminal infections and pelvic neurological changes. These data suggest that patients with DM1 should be counselled from an andrological-reproductive point of view.

Topics

Male Fertility Male Factor Causes Hormonal Causes

Male Fertility › Male Factor Causes › Hormonal Causes

Andrea Delbarba, Valentina Anelli, Francesca Bambini, Caterina Buoso, Paolo Facondo, Elisa Gatta, Angela Girelli, Carlo Cappelli, Alberto Ferlin

A Delbarba, V Anelli, F Bambini, C Buoso, P Facondo, E Gatta, A Girelli, C Cappelli, A Ferlin

PMID 38924386 38924386 DOI 10.1111/andr.13681 10.1111/andr.13681 Delbarba et al. 2025, Delbarba 2025

Type 1 diabetes mellitus and sperm quality: A case-control study

Young men with type 1 diabetes had poorer semen quality than controls

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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