JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):185
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263901

P-173. Pharmacological Management of Prediabetes and Diabetes Mellitus: Association with Sperm Motility

Camila Macedo Medina¹, Bruna Bizio Parra¹, Karla Pacheco De Melo¹, Janaina Romanini Da Silva¹, Ivan Henrique Yoshida¹, Michelli Suemi Tanada¹, Emerson Barchi Cordts¹, Caio Parente Barbosa¹

¹ Instituto Ideia Fertil de Saúde Reprodutiva - São Paulo - SP - Brasil

Objective: This study aimed to investigate the impact of pharmacological treatment on semen parameters in men diagnosed with prediabetes or diabetes mellitus (DM).
Methods: This retrospective study assessed semen quality, based on macroscopic and microscopic parameters, in patients who underwent semen analysis between January 2020 and July 2025 at a private fertility clinic in Brazil. A total of 262 patients with self-reported diagnoses of prediabetes or DM, as indicated in a clinical questionnaire completed prior to semen collection, were included. The parameters analyzed comprised ejaculate volume, sperm concentration, and motility (rapid progressive, slow progressive, non-progressive, and immotile), following the criteria established in the World Health Organization manual. Patients were distributed into two main groups: prediabetic (n=26) and diabetic (n=215). According to the type of pharmacological treatment for DM, four subgroups were defined: no medication (group 0; n=60), insulin only (group 1; n=32), metformin only (group 2; n=157), and combined insulin plus metformin (group 3; n=13). Statistical analysis was performed using the non-parametric Kruskal–Wallis test (significance level p<0.05), with the JAMOVI software (version 2.5.5).
Results: Pharmacological treatment for DM had a statistically significant impact on semen quality, regardless of disease severity (F=2.622, p<0.001). Regarding motility, a higher mean percentage of sperm with slow progressive motility was observed in groups 0, 1, and 2 compared with group 3: group 0 vs group 3 (9.58 vs 1.27; p=0.007); group 1 vs group 3 (9.18 vs 1.27; p=0.040); group 2 vs group 3 (10.7 vs 1.27; p<0.001). This result may be attributed to the higher rates of rapidly progressive motile sperm observed in group 3 compared to the other groups, although this difference represents only a trend and did not reach statistical significance (36.0 vs. 26.1, 26.6, and 28.2, respectively; p>0.05). Furthermore, group 0 had a lower mean percentage of immotile sperm compared with group 1 (31.5 vs 48.5; p=0.047). When analyzing only patients receiving insulin or metformin monotherapy, without other medications, a trend toward improved semen parameters such as increased ejaculate volume, sperm concentration, and rapid progressive motility was observed. However, these differences did not reach statistical significance, possibly due to the small sample size in these subgroups.
Conclusion: The findings of this study reinforce existing evidence that diabetes mellitus can impair sperm motility. Combined treatment with metformin and insulin was associated with a significant reduction in the proportion of sperm exhibiting slow progressive motility. Conversely, insulin monotherapy was linked to a higher proportion of immotile sperm. Although the present data do not allow definitive conclusions regarding the optimal therapeutic approach for preserving fertility in men with DM, the results suggest that combined insulin–metformin therapy may enhance semen quality. These observations align with previous literature, indicating that adequate glycemic control may improve semen parameters. This effect likely results from the restoration of metabolic homeostasis, which in turn reduces oxidative stress. Nevertheless, prospective studies with larger sample sizes and controlled designs are warranted to confirm and expand upon these findings.