DIABETES AND INFERTILITY IN WOMEN
Diabetes is a disorder of metabolism — the way our bodies use digested food for growth and energy. There are three main types of diabetes: type 1, type 2, and gestational diabetes. Normally, the pancreas releases insulin to help your body store and use the glucose and fat from the food you eat. Diabetes occurs in one of the following cases:
- When the pancreas do not produce any insulin
- When the pancreas produces very little insulin
- When the body does not respond appropriately to insulin, a condition called “insulin resistance”
There is no cure as such to diabetes. People who have diabetes need to manage their disease to stay healthy.
To understand why insulin is important in diabetes, we need to know more about how the body uses food for energy. Your body is made up of millions of cells. To make energy, these cells need food in a very simple form. When you eat or drink, much of your food is broken down into a simple sugar called “glucose.” This glucose is transferred through the bloodstream to the cells where it can be used to provide some of the energy your body needs for daily activities. The amount of glucose is strictly monitored by the hormone insulin. It is constantly being released in small amounts by the pancreas. When the amount of glucose rises beyond a certain level, the pancreas releases more insulin to push more glucose into the cells. This causes a drop in your blood glucose levels. To keep your blood glucose levels from getting too low (hypoglycaemia or low blood sugar), your body signals you to eat and releases some glucose from storage kept in the liver. People with diabetes either don’t make enough insulin or their body’s cells are resistant to insulin which could lead to high glucose levels in the body. A fasting blood glucose level (overnight fasting) of above 126 mg/dL is diagnosed as diabetes.
People with Type 1 diabetes produce no insulin and must use insulin injections to control their blood sugar.
People with Type 2 diabetes produce either very little insulin or their body is resistant to insulin.
If you are a woman dealing with Type 1 or Type 2 diabetes and are wondering if you can get pregnant, read on…
Can Diabetes cause infertility in women?
Diabetes Type 1 and Type 2 both should be considered in the differential diagnosis of both menstrual abnormalities and infertility. The reproductive period of a woman with diabetes may be substantially reduced due to delayed menarche and early menopause. Throughout their reproductive years, diabetic issues are linked to menstrual irregularities.
When it comes to diabetes and infertility the answer is clear: there is a connection. In many cases (especially among women), diabetes alone does not keep them from getting pregnant, but it oftentimes keeps them from staying pregnant. In many cases, say fertility doctors, “a woman with higher than normal glucose levels does get pregnant month after month. Unfortunately her diabetes status prevents that embryo from implanting in the uterus, causing a miscarriage before she even realizes she is pregnant.” In this case, the diabetes isn’t preventing conception, but is preventing an ongoing pregnancy. High glucose levels are reported to increase a woman’s chances of miscarriage by 30-60% according to statistics released by the American Diabetes Association. It was discovered that a good glycemic control enhances all these abnormalities and also raises fertility rates.
Even when implantation does occur, there are other risks considering, which include:
- An increased risk of birth defects due to damage caused to embryonic cells from high levels of glucose in the blood
- A larger baby resulting in a c-section, which increases a mother’s chances of infection
- An increased risk of gestational diabetes in the mother, which can cause other health concerns for both mother and baby
In addition to keeping an embryo from implanting, glucose levels that are too high can also affect hormone levels throughout the body including the all-important estrogen, progesterone and testosterone levels needed for a pregnancy to occur. That is why glucose control is so vital to your fertility.
Diabetes and Infertility in men
Remember that about 1/3 of infertility is male driven. Men too can experience infertility issues due to high glucose levels. Some experience retrograde ejaculation, where semen backs up into the bladder, making it impossible to get to the woman’s reproductive organs which become a problem. So does erectile dysfunction caused by both the diabetes itself as well as medications which may be used to control it. It also reduces ejaculate volume by affecting the small nerves that control ejaculation and by lowering testosterone levels.
Still, there is one, more dangerous reproductive side effect to diabetes in men: DNA damage. According to a research diabetes can and does cause serious DNA damage to sperm which can inhibit a pregnancy, live birth and even healthy, normal fetus.
What does all this mean? Simply put, a diabetic man who does not control his glucose levels has less of a chance of impregnating his partner and when he does, the risk of miscarriage and deformities are much higher.
What to do?
Diabetes in both men and women can be controlled. When it comes to controlling their diabetes in order to attain a healthy pregnancy, most doctors urge women to plan ahead for a pregnancy by doing the following:
- Get your weight to a normal level (the more obese you are, the harder it will be to control your glucose levels)
- Get your A1C levels below 6.5 before attempting to get pregnant
- Control your daily sugar levels for 3-6 months (the longer the better) to give your body the chance to prepare for a pregnancy.
The key to success, of course, is working with your endocrinologist and obstetrician to ensure that your glucose levels remain stable months before trying to conceive as well as during a pregnancy. With a good plan and dedication to eating right and staying healthy, your chances of giving birth are very high, despite a diabetes diagnosis.