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doi: 10.1530/eje.1.02086

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As for whether or not the drug increases fertility, Saleh asserted that it does so in an indirect manner

Although the exact mechanisms that contribute to diabetic complications remain unclear, it has recently been suggested that disequilibrium between toxic metabolites (e.g., advanced glycation end-products, protein kinase C activation), oxidative stress, and protective endogenous factors (e.g., insulin, vascular endothelial growth factor, platelet-derived growth factors, and adiponectin) may play a role in diabetic complications (Jeong and King, 2011)