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Reproductive System Symptoms

Testicular Atrophy

Primary hypogonadism in males (testicular atrophy) is usually not recognized until adulthood.  Symptoms can include:

  • Small testes, associated with decreased or absent sperm production. Infertility issues are more common in patients with DM1.
  • Weak secondary sex characteristics, including decreased energy, libido, sexual hair, muscle mass, and bone mineral density
  • Low serum testosterone (low or low-normal urinary 17-ketosteroid (17-KS) excretion, prohormone precursors of testosterone and estrone/estradiol)
  • Elevated serum FSH and LH concentration
  • Elevated FSH levels can result in high estradiol:testosterone ratios, leading to gynecomastia (breast enlargement in males)

Female Infertility

Reduced fertility is seen in females with DM.  Symptoms include:

  • Increased spontaneous abortion and stillbirth rate
  • Early menopause in rare cases

Pregnancy Complications

Maternal complications during pregnancy may include:

  • Prolonged labor and delivery related to uterine dysfunction, maternal weakness, and lack of voluntary assistance
  • Uterine overdistention, related to polyhydramnios, which can cause preterm labor, inadequate uterine contractions (atonic uterus), or premature spontaneous rupture of membranes
  • Myotonic spasms following the administration of depolarizing agents; respiratory depression following the administration of barbituates
  • Post-partum hemorrhage due to inadequate uterine contractions (atonic uterus) or retained placenta

Neonatal Complications

Fetal and neonatal complications in newborns with congenital DM1 may include:

  • Polyhydramnios (excessive accumulation of amniotic fluid due to decreased fetal swallowing) which is associated with increased risks of adverse pregnancy outcome
  • Umbilical cord prolapse or placental abruption
  • Fetal malposition due to greater fetal mobility
  • Pre-term labor
  • Hydrops fetalis
  • Fetal akinesia


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