Diabetes Mellitus ve İnfertilite
Özet
Diabetes Mellitus (DM), pankreasın insülin salgısındaki azalış veya insülin etkisindeki defektler sonucu gelişen, hiperglisemi ile karakterize küresel bir metabolik bozukluktur. Nüfus artışı, yaşlanma, kentleşme ve obezite gibi nedenlerle prevalansı hızla artan bu hastalık, birçok organ hasarına ve yüksek mortaliteye yol açmaktadır. Önceleri üreme sistemi üzerinde etkisi olmadığı düşünülse de, güncel çalışmalar DM'nin hem erkek hem de kadın infertilitesi ile doğrudan ilişkili olduğunu göstermektedir. Diyabetik erkeklerde libido azalması, erektil disfonksiyon, semen hacmi ile sperm sayı ve hareketliliğinde düşüş gözlenirken; testis dokusunda seminifer tübüllerde atrofi ve germ epitelinde bozukluklar saptanmıştır. Ayrıca DM, hipofiz-testis eksenini etkileyerek LH, FSH ve testosteron düzeylerini değiştirmektedir. Kadınlarda ise düzensiz menstrual siklus, ovaryum rezervlerinde azalma ve gebe kalma süresinin uzaması gibi olumsuz etkilere yol açmaktadır. Biyokimyasal açıdan incelendiğinde, DM kaynaklı kronik hiperglisemi reaktif oksijen türlerini (ROS) artırarak endojen antioksidan kapasiteyi düşürmekte ve oksidatif strese neden olmaktadır. Bu durum, hem erkek hem de dişi üreme sisteminde apoptozis (hücre ölümü) mekanizmasını tetikleyerek oosit olgunlaşmasını bozmakta, hücresel deformasyonlara yol açmakta ve neticede canlı doğum oranlarını düşürerek infertiliteye zemin hazırlamaktadır.
Diabetes Mellitus (DM) is a global metabolic disorder characterized by hyperglycemia, arising from a decrease in pancreatic insulin secretion or defects in insulin action. Rapidly increasing in prevalence due to factors like population growth, aging, urbanization, and obesity, this disease leads to extensive organ damage and high mortality rates. Although previously thought to have no significant impact on the reproductive system, recent studies clearly demonstrate that DM is directly associated with both male and female infertility. In diabetic men, decreased libido, erectile dysfunction, and reductions in semen volume, sperm count, and motility are observed, along with histopathological changes in testicular tissue such as seminifer tubule atrophy and germ epithelium degradation. Furthermore, DM disrupts the pituitary-testicular axis, altering LH, FSH, and testosterone levels. In women, it causes irregular menstrual cycles, reduced ovarian reserves, and prolonged time to pregnancy. Biochemically, chronic hyperglycemia induced by DM increases reactive oxygen species (ROS) and diminishes endogenous antioxidant capacity, causing oxidative stress. This oxidative stress triggers apoptosis mechanisms in both male and female reproductive systems, impairing oocyte maturation, inducing cellular deformities, and ultimately causing infertility by significantly lowering live birth rates.
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