Larissa Telfer Dietitian
When it comes to fertility the focus tends to be on women’s health. However sperm is providing half of the DNA and genetic make up of an embryo, and is therefore a crucial part of making a healthy baby.
Type 1 and Type 2 diabetes have been shown to impact men’s fertility. Research looking into the quality of sperm in men with diabetes found that higher amounts of sperm with irregular DNA, this can impact embryo quality, lower implantation rates and in some cases childhood diseases.
Back to Basics
Let’s take a step back to the basics of male reproduction. The process of making sperm is called spermatogenesis. Men produce sperm in the testis where it is stored with seminal fluid until ejaculation.
The process takes around 3 months with testes producing approx. 100 million viable sperm daily. Spermatogenesis is sensitive to changes in the environment such as temperature, dietary deficiencies and oxidative stress, which can lead to DNA damage.
How does diabetes affect male fertility?
Sperm require glucose to provide them with the energy required to reach and implant an egg. Glucose crosses from the bloodstream into the testis, sperm are sensitive to high glucose levels that occur as a result of diabetes. Studies in mice with diabetes showed changes in the way glucose is transported into cells as a result of reduced insulin and high BGLs.
Men with diabetes have higher levels of inflammatory agents in the fluid around the sperm, which is linked to DNA changes in sperm. Optimising BGLs improves pregnancy outcomes by reducing inflammatory agents and therefore DNA damage.
Erectile dysfunction is a complication in men with diabetes long term and occurs as a result of long-term damage that occurs during long periods of high blood glucose levels (BGLs).
Is there a difference between Type 1 and Type 2 diabetes?
Type 1 diabetes is an autoimmune condition that results in the loss of insulin producing beta cells in the pancreas. Onset usually occurs earlier in life although can be diagnosed at any age. Research has shown that high BGLs in men with type 1 diabetes have reduced sperm volume and sperm motility.
Type 2 diabetes is caused by insulin resistance, usually as a result of lifestyle factors such as obesity, dietary habits and lifestyle. This is combined with reduction in insulin production resulting in high blood glucose levels. The chronic inflammation drives changes in sperm DNA and sperm vitality.
What can I do to optimise my chances of falling pregnant?
The first goal for men with any type of diabetes is to engage with your diabetes team to optimise your BGLs. This means checking in with your diabetes specialist and diabetes educator for a check up on your medications, your lifestyle and check you are up to date with the latest technology available for people with diabetes.
It is important to remember that the risk of these factors impacting fertility can be reduced with optimising BGL control.
How can a Dietitian assist men with diabetes and fertility?
A dietitian experienced in fertility and diabetes will be able to provide individualised nutrition plan to optimise your BGL control and nutrition to improve chances of a healthy pregnancy.
The research into the impact of healthy eating on sperm quality continues to build, with higher intakes of nutrients including selenium, zinc, omega-3s and CoQ10 showing benefits. Dietary patterns such as the Mediterranean diet and the DASH diet are also showing benefits for sperm quality.
If you know a man with diabetes please share this article as you just don’t know who might be trying to conceive.
Larissa is available for in person consultations in Geelong, telehealth consultations are available.
Wiebe, J. et. al. Fertility is reduced in women and men with type 1 diabetes: results from type 1 diabetes genetics consortium (T1DGC) Diabetologia, 2014, 57:2501-2504.
Condorelli, R. et. al. Diabetes Mellitus and infertility: different pathophysiology effects in type 1 and type 2 diabetes on sperm function. Froniters in Endocrinology, 2018, 9:1-9.
Salas-Huetos, A. et. al. Diet and sperm quality: Nutrients, foods and dietary patterns. Reproductive Biology, 2019.
This recipe is a delicious and comforting vegetarian meal, it has been a hit in my house. Ideal for freezing for a quick mid-week dinner, or make a batch for workday lunches.
Makes 8 Serves
1/2 cup Yellow Thai curry paste
1.2kg pumpkin, chopped into large chunks
1 onion, diced
3 cloves garlic, finely chopped
1cm piece of ginger
1x chilli (optional)
2x 400g cans of chickpea, drained and rinsed
1 cup (250ml) vegetable stock
1 x 400g can Coconut milk
1 cup roasted cashews
Coriander to serve (optional)
1. Cook onion for around 5 minutes or until golden
2. Add ginger, garlic, chilli and cook for a few minutes, then add curry paste and cook until fragrant
3. Add pumpkin, coconut milk, vegetable stock and chickpeas
4. Simmer for around 30 minutes or until pumpkin tender
5. Prior to serving add roasted cashews and coriander
Nutrition per serve:
Energy 1500kj (360 calories), Protein 12g, Carbohydrate 28g, Fibre 9g.
Taking a pregnancy multivitamin is important to ensure you meet the increased nutritional needs of pregnancy. But choosing which brand or which nutrients you need to supplement can be confusing, leaving us to grab whatever is on special. Pregnancy multivitamins often include a large range of vitamins and minerals, but what nutrients are actually crucial to be taking?
The nutrients where supplementation is recommended for all pregnant women are:
Required for healthy cell division and for prevention of neural tube defects, the recommended daily intake (RDI) for folate significantly increases in pregnancy, particularly in the first trimester. Ideally folate supplements should be started at least one month prior to conception. Most pregnancy multivitamins contain 500mcg, which is adequate for most women when combined with dietary intake. However, women with some conditions such as diabetes, require much higher doses of folate up to 5000mcg due to increased risk of neural tube defects.
Required for the regulation of thyroid function and metabolism, also crucial for baby’s brain and nervous system development. Iodine deficiency in pregnancy has been link to poorer academic performance in children. For this reason the RDI for iodine increases in pregnancy to 220mcg from 150mcg prior to pregnancy. Supplementation in pregnancy is recommended to assist meeting these increased needs. Pregnancy multivitamins contain between 150mcg to 250mcg.
In case of nutritional deficiency:
Essential in pregnancy for the regulation of calcium and phosphate levels, important for the development of bone strength in the developing baby. Vitamin D deficiency in pregnancy has been associated with increased risk of preeclampsia, gestational diabetes and low birth weight. Children of mothers with deficient vitamin D in pregnancy have reduced bone size and strength. The amount of Vitamin D in pregnancy multivitamins ranges from 200-1000IU. Vitamin D levels can be checked by a blood test to help determining how much Vitamin D you should be taking.
Iron is a key component in haemoglobin in our blood. The RDI for iron increases from 18mg to 27mg during pregnancy due to the extra blood volume. Routine supplementation is not recommended unless blood levels are low. Pregnancy multivitamins usually contain iron ranging from 7.5mg to 60mg to assist reaching the increased RDI. However, more is not always better as many women experience nausea and GI upset as a side effect of iron supplements.
Other nutrients commonly included in pregnancy multivitamins include Calcium, Magnesium, Vitamin B12, Vitamin B3 (Niacin), Zinc, Omega-3’s, Selenium and Choline. Supplementation is advised when dietary intake is inadequate, for example, women not consuming enough dairy foods should take 1000mg calcium supplement daily.
It is important to remember that multivitamins are a supplement to what we eat and can’t replace a healthy diet. If you are avoiding certain food groups you may need higher doses of some nutrients. However, more is not always better too much of some nutrients can have detrimental effects on baby’s development.
If you want to check which nutrients supplements you should be taking for pregnancy and conception a prenatal Dietitian will be able to tailor a plan for you, taking into account your food intake and individual needs.
RANZCOG, Vitamin and mineral supplementation and pregnancy (C-Obs 25), Nov 2014