Men's Health Alert: The Fertility Triangle

Prayagraj : Type 2 diabetes is a reproductive risk, not just metabolic. Dr. Madhulika Singh warns couples considering ART about the Diabetes-Low Testosterone-Fertility triangle. Rising blood sugar, declining T, and impaired sperm quality create a vicious cycle. Addressing this hormonal and metabolic link is key to successful conception outcomes.

READ MORE : Why Nutrition is the Missing Piece in India's Fertility Puzzle

 Blood sugar and sperm health

Men with uncontrolled diabetes show measurable impairments in their reproductive function. One study involving 20,000+ obese men and over 1,300 diabetic men found that diabetes is associated with significantly reduced semen volume, lower sperm count, and diminished motility compared with non-diabetic controls. In another study, diabetes was described as impairing not only sperm count and motility but also causing DNA fragmentation and epigenetic changes in sperm.

 What this means in practice is that glycaemic imbalance may compromise sperm before any fertility treatment even begins.

 Testosterone as the missing link

Low testosterone frequently co-exists with type 2 diabetes. In one study of men with type 2 diabetes and metabolic syndrome, low-testosterone levels were common and identified men with worse metabolic profiles. The same study that looked at sperm parameters found that testosterone levels were on average lower in diabetic men compared to those without diabetes.

 Testosterone matters for fertility in multiple ways. It supports the spermatogenic environment, influences libido and sexual function, and affects partner-timing. If testosterone is low, even the most advanced treatment may face a less favourable starting point. 

Why the triangle matters in fertility care

When a couple is exploring fertility options, it’s natural to focus on sperm counts, motility, morphology and the female partner’s parameters. But failing to factor in men’s metabolic and hormonal health may lead to sub-optimal outcomes or surprises later. A man with type 2 diabetes may present with borderline sperm numbers but also undisclosed low testosterone and high oxidative stress. Recognising the triangle means:

 ●        Screening men with diabetes (or pre-diabetes) for testosterone and semen health early

●        Intervening with metabolic optimisation (diet, exercise, glycaemic control), which can improve testosterone and sperm parameters and thus strengthen the overall fertility strategy

●        Framing discussions about fertility not merely as “can we do IVF?” but as “let’s give your body the best chance first.”

(Report by Zainul Abdin)