Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 110

In general, patients undergoing assisted reproduction techniques (ART) are healthy individuals, but due to a rise in the prevalence of diabetes mellitus and impaired glucose tolerance globally over recent decades [1], it is not uncommon to see more and more diabetic couples seeking ART. For those providing ART, managing such couples is challenging, especially if the patient has type 1 or poorly controlled diabetes.

In animals, studies have shown that (a) diabetes is associated with ovarian atrophy, poor follicular development, impaired steroidogenesis and reduced progesterone levels [2], and (b) insulin administration corrects impairment of in‐vitro oocyte maturation and early pre‐embryonic development [3]. In women with well‐controlled type 1 (insulin dependent) diabetes, response to gonadotropin stimulation, fertilization and cleavage rates have been shown to be the same as those in women without diabetes [4,5]. The follicular fluid milieu in patients with well‐controlled type 1 diabetes is almost the same as in women without diabetes, except for the absence of epidermal growth factor.

In males, type 2 diabetes is known to be associated with reduced testosterone levels secondary to insulin resistance [6]. Although sex hormone binding globulin (SHBG) level is low with insulin resistance, the free testosterone level has been shown to be low in one‐third of men with diabetes [7]. Clinically, this could present as hypogonadism with symptoms and biochemical evidence of testosterone deficiency.