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Undiagnosed prediabetes common among men with primary infertility
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Many men presenting with primary infertility also had undiagnosed prediabetes, and these men were more likely to have lower circulating total testosterone and sex hormone-binding globulin, according to findings from a cross-sectional study published in BJU International.
“A significant number — approximately 15% — of primary infertile men had criteria suggestive of undiagnosed prediabetes,” Luca Boeri, MD, a urology resident in the division of experimental oncology at IRCCS Ospedale San Raffaele in Milan, told Endocrine Today. “Moreover, infertile men with prediabetes are at a greater risk for hypogonadism, higher DNA fragmentation index values and idiopathic nonobstructive azoospermia status.”
Boeri and colleagues analyzed data from 744 white men evaluated at a single center for infertility (defined as not conceiving a pregnancy after at least 12 months of unprotected intercourse) and diagnosed with male factor infertility between September 2015 and September 2017. Men underwent two consecutive semen analyses, both showing below standard values for normal semen parameters according to WHO criteria, and provided fasting blood samples. Researchers measured lipid profiles, HbA1c, fasting glucose, follicle-stimulating hormone, luteinizing hormone, 17-beta-estradiol and total testosterone. Prediabetes was defined as fasting glucose between 100 mg/dL and 125 mg/dL (impaired fasting glucose), 2-hour plasma glucose concentration between 140 mg/dL and 199 mg/dL following a 75-g oral glucose tolerance test (impaired glucose tolerance) or HbA1c at least 5.7%.
Within the cohort, 114 men (15.4%) had prediabetes.
The researchers found that men with prediabetes and primary infertility tended to be older, had higher comorbidity scores and lower levels of total testosterone and SHBG, but higher levels of follicle-stimulating hormone and estradiol vs. men without prediabetes (P .04 for all comparisons).
Idiopathic nonobstructive azoospermia occurred more frequently in men with prediabetes vs. men without prediabetes (33.3% vs. 12.9%; P < .001). Additionally, researchers observed higher DNA fragmentation index values and a greater number of DNA fragmentation index values of at least 30% in men with prediabetes vs. men without prediabetes (P .02 for all). In Spearman’s correlation analysis, the higher the fasting glucose, the greater the DNA fragmentation index value (r = 0.31; P < .001). Researchers did not observe a correlation between seminal parameters and fasting glucose level.
In logistic regression models, the researchers found that older age (OR = 1.01; P = .001), follicle-stimulating hormone levels (OR = 1.03; P = .03) and idiopathic nonobstructive azoospermia (OR = 1.91; P = .04) were independently associated with prediabetes. Results persisted after adjustment for BMI, Charleston comorbidity index score and testicular volume.
“Since prediabetes is a common but underdiagnosed condition and has been considered a relevant risk factor for the further development of metabolic and cardiovascular diseases, our results stress the importance of glucose metabolism investigation during every basic infertility workup,” Boeri said. “Moreover, the early identification of a prediabetes status is clinically relevant in order to adopt preventive strategies to attempt and reduce sequelae of a misunderstood and long-standing poor glycemic control.”
Boeri said their model, based on age, follicle-stimulating hormone levels and idiopathic nonobstructive azoospermia status, showed a good clinical benefit when applied to select patients at higher risk for prediabetes, and should be investigated further. – by Regina Schaffer
For more information:
Luca Boeri, MD, can be reached at the Division of Experimental Oncology, Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy; email: luca.boeri@hotmail.it.
Disclosures: The authors report no relevant financial disclosures.
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