Type 1 and type 2 diabetes mellitus are chronic medical conditions.
According to the International Diabetes Federation (IDF) Diabetes Atlas, published in November 2021, the number of adults living with diabetes mellitus (DM) worldwide increased from 108 million in 1980 to 537 million in 2021.
Type 1 diabetes is characterized by insulin deficiency resulting from autoimmune destruction of the insulin-producing β-cells of the pancreas, leading to an absolute requirement for insulin replacement. Type 2 diabetes is the most common form of diabetes mellitus and was previously referred to as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes.
Both male and female fertility can be adversely affected by type 1 and type 2 diabetes through a variety of mechanisms. Today, a growing number of individuals worldwide face infertility associated with diabetes, often compounded by poor glycemic control and unhealthy lifestyle factors.
Approximately 90% of men with diabetes experience some degree of sexual dysfunction, including reduced libido, erectile dysfunction, and ejaculatory disorders, all of which may contribute to impaired fertility.
Although the majority of individuals with type 2 diabetes are postmenopausal women and older men, changes in dietary habits and lifestyle, together with the rising prevalence of obesity, have led to an increasing incidence of type 2 diabetes among people of reproductive age.
Diabetes mellitus appears to induce molecular alterations that adversely affect both sperm quality and function. Although sperm cells produce their own insulin, they remain highly sensitive to hormonal fluctuations. Consequently, insulin deficiency in type 1 diabetes or insulin resistance in type 2 diabetes alters the endocrine environment, with potentially detrimental effects on male reproductive function.
Studies have demonstrated significant reductions in semen volume, sperm motility, and normal sperm morphology in men with diabetes. These adverse effects on male reproductive function are thought to be largely mediated by oxidative stress, which results from an imbalance between the production of reactive oxygen species (ROS) and the body's antioxidant defense mechanisms.
Increased oxidative stress may lead to sperm DNA damage and mitochondrial DNA fragmentation. In addition, diabetes has been associated with structural and functional changes in the testes, including alterations in the morphology and number of Sertoli cells, a reduction in the number of Leydig cells, changes in the structure and composition of the epididymis, and decreased levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone. Furthermore, diabetic neuropathy is one of the most common complications of diabetes mellitus and may also contribute to impaired male reproductive function.
Diabetic neuropathy has been reported to affect approximately 50% of individuals with both type 1 and type 2 diabetes. It may result in impaired sexual function, including reduced sexual responsiveness, erectile dysfunction, and retrograde ejaculation, thereby contributing to male infertility.
Both type 1 and type 2 diabetes are associated with impaired female reproductive function. This dysfunction may manifest as delayed menarche, menstrual irregularities, hormonal disturbances, polycystic ovary syndrome (PCOS), diminished ovarian reserve, sexual dysfunction, and premature menopause. Collectively, these conditions can have a significant adverse impact on female fertility.
The underlying pathophysiological mechanisms are thought to include dysfunction of the hypothalamus, pituitary gland, and ovaries—reflecting disruption of the hypothalamic–pituitary–ovarian (HPO) axis—as well as metabolic abnormalities that contribute to impaired reproductive function.
In addition, the presence of diabetic microvascular or cardiovascular complications has been associated with significantly reduced fertility. Finally, there is a bidirectional relationship between gestational diabetes mellitus (GDM) and infertility. Gestational diabetes may also increase the risk of fetal death and congenital anomalies, highlighting the importance of appropriate preconception care and optimal glycemic control.
Poor glycemic control and the presence of diabetes-related complications are associated with reduced fertility in both men and women. Preconception care should be integrated into routine diabetes management from adolescence onwards. Evidence suggests that achieving optimal metabolic control before conception may improve fertility and contribute to better reproductive outcomes.
Evidence suggests that when diabetes is well controlled, its adverse effects on fertility are reduced, and achieving tighter metabolic control may improve reproductive potential. In general, the management of diabetes and diabetes-related infertility focuses on optimizing blood glucose levels. This includes lifestyle and dietary modifications, regular physical activity, and ongoing monitoring of blood glucose as part of a comprehensive approach to improving both overall health and reproductive outcomes.
For individuals with type 1 diabetes, insulin therapy remains the cornerstone of treatment. In type 2 diabetes, management may include oral glucose-lowering medications and/or insulin therapy, depending on the individual's clinical needs. For people with obesity-related diabetes, achieving and maintaining a healthy body weight can significantly improve fertility and enhance reproductive outcomes.
Weight loss achieved through a balanced diet and regular physical activity can help restore hormonal balance and increase the likelihood of conception. In addition, antioxidant supplementation may help reduce the oxidative damage that diabetes can cause to reproductive cells—including both oocytes and spermatozoa. Antioxidants may also improve sperm quality in men and support oocyte health in women, although their use should be considered on an individual basis and guided by clinical evidence.
In conclusion, the evidence clearly highlights the importance of integrating preconception care into routine diabetes management, beginning as early as possible—ideally from adolescence in individuals with type 1 diabetes. Early counseling, optimal metabolic control, and timely reproductive planning can help improve fertility, reduce pregnancy-related risks, and promote better maternal and fetal outcomes.
Lifestyle Changes to Support Your Fertility
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