Endocrine Abstracts

Diabetes mellitus type 1 (DM1), an autoimmune disease, affects an increasing number of young men in reproductive age. It has been estimated that its prevalence increases at a rate of ~3% per annum. Diabetes may affect male reproductive function by acting on the hypothalamic-pituitary-testicular axis, causing sexual dysfunction and disrupting male accessory gland function. According a recent study shows that men with DM1 have a smaller number of live births than controls. Despite such evidence, little is known about sperm parameters (mainly limited to conventional sperm parameters) and other aspects of the male reproductive function in these patients. Therefore, this study was undertaken to evaluate both conventional and non-conventional sperm parameters, serum gonadal hormones and didymo-epididymal ultrasound features in patients with DM1. To accomplish this, 30 patients with DM1 (aged 18–35 years) and 20 age-matched fertile healthy men were enrolled in this prospective study. Patients with diabetic neuropathy, other endocrine disorders or conditions known to alter sperm parameters were excluded from the study. Conventional sperm parameters were evaluated according to the WHO 2010 criteria. As far non-conventional sperm parameters, mitochondrial function (mitochondrial membrane potential, MMP), apoptosis and chromatin/DNA integrity were evaluated by flow cytometry following specific staining. Serum total testosterone, 17β-oestradiol, LH, FSH and prolactin were measured in all patients and controls. Finally, testicular and epididymal morphometry was evaluated by ultrasound scan before and after ejaculation. Patients with DM1 had a significantly lower percentage of spermatozoa with progressive motility than controls. This abnormality was significantly lower in DM1 patients with long (>10 years) than short (<5 years) disease duration. In addition, the percentage of spermatozoa with high MMP was significantly lower in DM1 patients than in controls. This non-conventional parameter was significantly worse in patients with long or intermediate (5–10 years) vs short DM1 duration. Disease duration correlated inversely with the percentage of spermatozoa with high MMP. Patients with DM1 had a significantly higher cephalic and caudal epididymal diameters after ejaculation compared to controls, suggesting a lack of the physiological epididymal post-ejaculatory shrinkage. This aspect of the epididymal physiology was significantly more compromised in patients with long vs short disease duration. All the other parameters did not show any statistically significant difference. Finally, HbA1c did not correlate with any of the parameters evaluated. In conclusion, patients with DM1 had lower sperm progressive motility, impaired mitochondrial function (which precedes the onset of motility disturbance) and epididymal post-ejaculatory dysfunction which cannot be ascribed to endocrinopathy and/or neuropathy. These findings may explain why patients with DM1 experience fertility disturbance.