Type 2 diabetes mellitus increases surgical sperm retrieval but preserves semen quality and cumulative live birth rate.

RESEARCH QUESTION: What is the effect of male type 2 diabetes mellitus (T2DM) on semen parameters, surgical sperm retrieval (SSR) rates and cumulative live birth rate (CLBR) in couples undergoing assisted reproductive technology (ART), when controlling for confounders?

DESIGN

Single-centre retrospective cohort study (couples: n = 1462; T2DM: n = 293; non-diabetic: n = 1169) were selected from 44,630 initial cycles using 1:4 propensity score matching for male age, body mass index and female prognostic factors.

RESULTS

The T2DM group had a significantly higher SSR rate (22.2% versus 4.9%, P < 0.001; adjusted OR 4.80, 95% CI 3.24 to 7.12). Semen volume was reduced (2.2 versus 3.0 ml, P < 0.001) and sperm concentration was higher (52.0 versus 43.8 million/ml, P = 0.003) in the T2DM group, but no significant differences were found in total sperm count, progressive motility, morphology, fertilization rate or available embryos. The CLBR was comparable between the T2DM and non-diabetic groups (45.4% versus 47.9%, P = 0.467; adjusted OR 0.81, 95% CI 0.59 to 1.11). Subgroup analysis of T2DM patients based on glycated haemoglobin levels (<7.0%, 7.0-8.4%, >8.4%) revealed that poorer glyacemic control was associated with longer diabetes duration, higher FSH levels and reduced semen volume, but it did not significantly affect the SSR rate, other semen parameters or CLBR.

CONCLUSION

Although male T2DM is strongly associated with surgical sperm retrieval, it does not impair conventional semen quality or cumulative live birth rate in ART. Furthermore, within the T2DM population, varying degrees of glycaemic control do not significantly affect ART outcomes.