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Understanding the Link Between Diabetes and Infertility

Type 1 and type 2 diabetes can lead to infertility in both men and women, but lifestyle changes & our treatments can help

Woman worried about diabetes and infertility has her blood sugar checked | Tennessee Reproductive Medicine | Chattanooga, TNDiabetes is a disease in which there is too much sugar, or glucose, in the bloodstream, signifying that the body cannot regulate sugar properly. It affects both men and women and is known to cause significant health problems, including heart attack, stroke, blindness, kidney failure and, especially for women, reproductive system problems.

Chronic diabetes includes type 1 diabetes and type 2 diabetes. Prediabetes can lead to type 1 and type 2 if not managed. Gestational diabetes occurs during pregnancy.

About 1 in 9 women in the United States have type 2 diabetes, which is more common (90%-95% of chronic diabetes cases) than type 1. It is not uncommon for patients with both types of diabetes to experience infertility issues. Because more people have type 2 diabetes, it affects many more people’s fertility.

Talk to a fertility specialist sooner rather than later

Diabetic women who want to get pregnant should meet with a fertility specialist as soon as they decide they want to conceive. A doctor who specializes in fertility can offer expertise and advice about the proven factors that link diabetes and infertility. The disease should be well managed before trying to conceive.

What are the causes of diabetes?

The exact cause of type 1 and 2 diabetes isn’t known. Genetics and environmental factors are suspected causes.

In type 1 diabetes, the pancreas (organ that produces insulin) has difficulty making sufficient amounts of insulin. In type 2 diabetes, there tends to be more difficulty with the body’s ability to efficiently use insulin, insulin levels are higher and the body becomes more resistant to insulin’s effects. When blood sugar levels are too high, it causes cells in the body’s muscle, fat and liver to become resistant to insulin. These cells don’t burn enough sugar, leaving an excess to circulate and eventually get stored as fat in the body.

Fat that gets stored in the abdominal area (instead of the thighs and hips) increases risk for diabetes. Women with a waist circumference above 35 inches and men with waists larger than 40 inches are known to be at higher risk for a diabetes diagnosis.

A prevalent risk factor for developing type 2 is being overweight. Being overweight (classified by the Centers for Disease Control and Prevention as a body mass index (BMI) of 25 to 29.9) or obese (a BMI of 30 or higher) are the main risk factors for type 2 diabetes.

The association of unhealthy weight with infertility

Being overweight or obese due to diabetes – or due to any other factor – has a direct effect on fertility, in women and men. Excess body weight for women, especially at obese levels, and type 2 diabetes interfere with the ovarian reproductive hormone production. Well-documented research correlates obesity with infertility, lower conception rates, higher miscarriage rates and pregnancy complications.

Being underweight or overweight can change ovarian function. Studies have also found that most overweight or obese women have a partner who is also overweight or obese. For men, being overweight can affect testosterone and sperm production. Weight loss can significantly increase total sperm count and the percentage of sperm with normal structure and motility.

We highly recommend that men and women who are trying to conceive and who may have weight issues seek to address this condition to improve their chance of natural conception, as well as success with fertility treatments.

How type 1 diabetes affects infertility in women and men

Evidence indicates type 1 diabetes in men harms sperm production and sperm health, which affects fertility. However, the direct impact is not well understood at this time.

Type 1 diabetes’ effect on female infertility is also a concern, with studies showing fewer live births in women with type 1 diabetes than in nondiabetics.

Type 2 diabetes also causes female and male infertility

Male infertility and type 2 diabetes

The changes in blood sugar from type 2 diabetes can alter testosterone levels. This can reduce sperm production and sperm quality, which can be the result of DNA damage from oxidative stress. Another effect on male fertility is that men with type 2 diabetes are more prone to conception problems associated with erectile dysfunction and ejaculation issues.

Type 2 diabetes and infertility in women

Evidence in the Fertility and Sterility journal shows that women with type 2 diabetes have a lower birth rate (62.6%) than nondiabetic women (83.8%). They also have a higher miscarriage rate.

This condition affects not only a woman’s ability to ovulate eggs but also can affect embryo implantation after fertilization. Women with type 2 are more apt to have irregular periods, anovulation (no ovulation) and polycystic ovary syndrome (PCOS). All can negatively affect a woman’s fertility.

Research indicates that there may be a link between PCOS and insulin production. Women with polycystic ovary syndrome are often insulin resistant, which increases their risk for type 2 diabetes. Obesity can also cause hormonal changes that lead to PCOS.

Another aspect of type 2 diabetes and reproduction is that it can cause birth defects. Unhealthy blood sugar levels can affect a baby’s vital organs while they are developing and cause serious birth defects of the brain, spine and heart.

Low libido in women & men

Both types of diabetes can affect sexual desire in men and women due to blood sugar levels that are too high or too low. Either can alter one’s physical and emotional feelings and result in low libido (sexual desire or energy). Low libido in either partner can reduce sexual activity considerably and serve as an indirect cause of infertility.

Fertility self-help for those with diabetes

Despite the somewhat intimidating statistics, there is hope for pregnancy for those with diabetes. For diabetics who are overweight or obese, the first step is to achieve a healthy weight, which helps manage blood sugar levels. Sometimes this can avoid the need for fertility treatments.

Steps may vary according to an individual’s health and the type of diabetes. You should discuss your weight loss (or gain) plan with a physician. Time, too, is an important consideration for overweight women with type 2 diabetes who want to get pregnant. Losing weight in a healthy way takes time.

How to lower BMI and improve fertility

Lowering BMI has been shown to improve reproductive outcomes, including fertility. Even a small amount of weight loss can result in improvements in ovulation, pregnancy rate and successful pregnancies.

Eating foods that are lower in fat and calories while integrating more activity into day-to-day life can help reverse infertility factors. Incorporating more whole grains, fruits and vegetables into the diet will help moderate blood sugar, as will adding brisk walking, biking or swimming to a daily routine. Also, be sure to get up every 30 minutes and move around for at least a few minutes.

Related reading: Take our quiz to see how your diet may affect your fertility

Fertility treatments for diabetics

If an individual’s efforts don’t result in conception, it is probably time to consider fertility treatments. We will work with the person’s doctor to make sure blood sugar levels are in good shape before administering fertility treatments. These include the following.

  • Fertility medications can help improve ovulation in women with diabetes, as well as help with PCOS. Different medications can assist men with erectile problems.
  • Intrauterine insemination (IUI) can improve chances of conception for men with sperm health issues and in couples with unexplained infertility
  • In vitro fertilization (IVF) can be successful in addressing a variety of infertility issues. Intracytoplasmic sperm injection (ICSI) may also be used in conjunction with IVF.
  • Men with severe sperm production problems may need a sperm extraction surgical procedure.