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This application helps to propose an appropriate fertility therapy method and to find the most suitable clinic worldwide based on the price, duration and legislative options of the treatment in various countries.

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Diabetes mellitus treatments

Self therapy does not exist.

Medical nutrition therapy

Medical nutrition therapy (MNT) is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a medical doctor, registered dietitian or professional nutritionist. The diet is based upon the patient's medical record, physical examination, functional examination and dietary history.

The role of MNT when administered by an MD or DO physician, dietitian or professional nutritionist is to reduce the risk of developing complications in pre-existing conditions such as type 2 diabetes as well as ameliorate the effects any existing conditions such as high cholesterol.

Assisted reproduction therapy does not exist.

How can Diabetes mellitus affect fertility

When a couple seeks medical help, one of the first conditions the doctor will look for is diabetes since the condition can cause fertility complication in both genders. In most instances, simple lifestyle changes like adequate nutrition and weight loss through proper exercise can help reverse the effects of infertility (Pic. 1).

Effects of diabetes mellitus on male fertility

Certain diabetic complications can cause issues for men that contribute to infertility (Pic. 2). As DM has profound effects on the neuroendocrine axis, in men, both DM1 and DM2 have long been recognized as major risk factors for sexual and reproductive dysfunction. This primarily includes impotence/erectile dysfunction (ED), ejaculatory (retrograde ejaculation) and orgasmic problems. Nerve damage or autonomic neuropathy due to diabetes can lead to retrograde ejaculation – where the semen goes into the bladder. Since the semen never reaches the female reproductive system, infertility may be an issue. 

The majority of patients with Type 2 diabetes are overweight or obese, which leads to decreased testosterone levels and elevated pro-inflammatory cytokines (substances produced in the cell). This can induce dysfunction in the blood vessel wall through the socalled nitric oxide pathway and further explain the relationship between DM2, obesity and erectile dysfunction. Erectile dysfunction, or the inability to achieve an erection, is another diabetes complication that can lead to fertility problems in diabetic men.

Increase in the size or number of adipocytes as a result of obesity can result in both physical changes and hormonal changes. Physical changes can include an increase in scrotal temperature, an increase in the incidence of sleep apnea, and an increase in ED. Hormonal changes might include increases in the levels of leptin, estrogen and insulin, and a decrease in the level of testosterone. These changes, in turn, contribute to oligozoospermia, azoospermia, an increase in the DNA fragmentation index (DFi), and a decrease in semen volume. All three categories of change contribute to obesity-linked male infertility. The increase in estrogen and decrease in testosterone levels negatively affects spermatogenesis as well as regular testicular function.
It is therefore clear that DM can be associated either directly or indirectly with several disorders of the male reproductive system and sexual functioning, but impaired spermatogenesisis is also associated with DM.

Effects of diabetes mellitus on female fertility

Despite the fact that more women suffer from DM than men, and that women share similar risks for diabetic complications with men, less attention has been given to sexual function in women with DM. The prevalence of female sexual dysfunction (FSD) and associated risk factors in diabetic women are less clear than in men. Sexual problems in women with DM may be explained by several possible mechanisms, including biological, social, and psychological factors :

  1. Hyperglycemia may reduce the hydration of mucous membranes in the vagina, leading to decreased lubrication and dyspareunia.
  2. Increased risk of vaginal infections increases the risk of vaginal discomfort and dyspareunia.
  3. Vascular damage and neuropathy may result in decreased genital blood flow, leading to impaired genital arousal response.
  4. Psychosocial factors such as adjustment to the diagnosis of DM, the burden of living with a chronic disease, and depression may impair sexual function.

The main diabetes complication (including gestational diabetes) related to pregnancy is macrosomia - or a big baby (higher than the 90th percentile in birth weight). Sometimes these babies are not able to pass through the birth canal, so there are higher incidences of caesarean sections, and sometimes it is necessary to induce labor early. Fetal distress can also become an issue. There is also an increased risk of birth defects. This condition is directly related to maternal diabetes problems, especially during the first few weeks when a woman may be unaware she is pregnant. For this reason, women with diabetes are advised to manage their insulin levels under control before attempting to conceive. Conditions associated with insulin resistance, such as obesity and DM, are often accompanied by increased adiposity or hyperglycemia.

Pic. 2: Diabetes Mellitus
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