Impact of Diabetes Mellitus and Obesity on Male Infertility in Iraqi patients

Abstract

Background: Several studies have highlighted the high prevalence of low Total Testosterone (TT) and Free Testosterone (FT) in men with type 2 diabetes and demonstrated links with visceral adiposity, insulin resistance and HbA₁C. The aim of this study is to evaluate the role of diabetes alone and the association of diabetes and obesity on prevalence of infertility in Iraqi male. Subjects and Methods: This case-control study was carried out at Al-Amam Ali Hospital and The Specialized Center For Diseases of Endocrines & Diabetes, Baghdad- Iraq, during the period from December 2011 to April 2012. It consisted of 63 male patients with type 2 Diabetes Mellitus (DM) and 25 healthy controls . Diabetic patients were further subdivided into the three groups according to their BMI as: 1. Diabetic Normo BMI group(n=28, BMI18 -25 kg/m² ), 2. Diabetic Overweight group(n=11 BMI 25 - 30 kg/m² ),and 3. Diabetic Obese group(n=24; BMI was over than 30 kg/m²). Investigations included serum measurements of fasting serum glucose, HbA₁C(using spectrophotometric technique), follicle stimulating hormone FSH, lutilizing hormone LH, prolactin, free testosterone by using ELISA technique in patient groups and healthy controls. Results: The mean(±SD) values of HbA₁C of diabetic obese, diabetic overweight, and diabetic normoBMI patients were higher than that of healthy controls(for all; P<0.0001). Also, the mean values of HbA₁C of diabetic normoBMI was significntly increased compared to that of diabetic obese(P<0.025). However, there was no significant difference in mean value of HbA₁C between diabetic overweight and diabetic obese. Serum levels of FSH, LH, and prolactin did not differ significantly among the patient groups and controls. Serum mean value of free testosterone of diabetic obese patients was significantly lower than that of diabetic overweight (P<0.016) and healthy controls (P<0.001), but did not differ significantly between the diabetic overweight and diabetic normoBMI with control group. The results also showed that there was significant negative correlation between the serum free testosterone levels and the HbA₁C values in diabetic obese group(r=-0.455, P<0.025). Conclusion: This study revealed that association of diabetes mellitus and obesity but not diabetes alone have significant impact on deficiency of free testosterone and consequent sub fertility in male not suffering from primary or secondary causes of infertility.