Study investigates potential link between type 1 diabetes and male infertility

Omer A. Raheem, MD, MSc

In this interview, Omer A. Raheem, MD, MSc, discusses the recent Société Internationale d’Urologie Journal study, “Does Type 1 Diabetes Affect Male Infertility: Type 1 Diabetes Exchange Registry-Based Analysis,”¹ for which he served as a study author. Raheem was an assistant professor of urology at Tulane University at the time of the research and is now an assistant professor of urology at the University of Chicago. This study was conducted in collaboration with the department of urology and the division of Metabolism, Endocrinology, and Nutrition at the University of Washington.

Please discuss the background for this study.

Not surprisingly, the prevalence of type 1 diabetes, has been increasing over the last few decades and is commonly believed to negatively affect male fertility.² First, we wanted to evaluate the prevalence of male infertility among men with type 1 diabetes. Secondly, we wanted to characterize the risk factors and clinical predictors for developing male infertility among men with type 1 diabetes. The main question for the study was: Does type 1 diabetes impact male fertility? We analyzed data collected from more than 2000 men diagnosed with type 1 diabetes over a 5-year period, obtained from the T1D Exchange Registry. Data included a number of clinical variables such as the age of diagnosis of diabetes, duration of diabetes, A1C levels, and others. As it pertains to male infertility, there were questionnaires specifically for male infertility, where the participants were asked whether they had any problems conceiving during their lifetime and whether they received any abnormal results from their infertility testing.

What were some of the notable findings? Did any of them come as a surprise to you and your co-authors?

Interestingly, we found that the prevalence of male infertility in men with type 1 diabetes was 1.5%, comprising 33 out of more than 2000 men diagnosed with type 1 diabetes who reported male infertility. Furthermore, on multivariate analysis, we also found that older men with type 1 diabetes and men with a manifestation of renal impairment, like presence of renal failure and micro/macroalbuminuria related to diabetes, are at a greater risk of developing infertility in their lifetime. Specifically, for each year of advancing age men were 5% more likely to experience infertility.

What would you say is the take-home message for the practicing urologist?

Indeed, this study was able to answer some of the important questions pertaining to male infertility in men with type 1 diabetes. It underpins the critical role of practicing urologists in educating and counseling diabetic men and its potential implication on male infertility. It is critical to be aware of this association, provide proper counseling, and discuss management options for this growing at-risk population.

Is there anything else that you feel that our audience should know about this research?

A potential genetic link between diabetes and male infertility may exist as a recent study identified over 100 genes associated with both male infertility and several disease mechanisms, including metabolic disease pathways. It seems plausible that targeted gene mutations could lead to both male infertility and diabetes.^3,4 There are exciting times ahead, but further transitional research of both male fertility and diabetes are warranted to further validate and confirm these results.

References

1. Raheem OA, Hehemann MC, Rogers MJ, et al. Does type 1 diabetes affect male infertility: Type 1 Diabetes Exchange Registry-based analysis. Société Internationale d’Urologie Journal. 2021;2(3):139-143. https://doi.org/10.48083/VVMV5977

2. Biggs ML, Mukamal KJ, Luchsinger JA, et al. Association between adiposity in midlife and older age and risk of diabetes in older adults. JAMA. 2010;303:2504-2512. doi:10.1001/jama.2010.843

3. Tarin JJ, Garcia-Perez MA, Hamatani T, et al. Infertility etiologies are genetically and clinically linked with other diseases in single meta-diseases. Reprod Biol Endocrinol. 2015;13:31. doi:10.1186/ s12958-015-0029-9

4. Matzuk MM, Lamb DJ. The biology of infertility: research advances and clinical challenges. Nat Med. 2008;14:1197-1213