Oh, Sugar! How Diabetes and Prediabetes Affect Fertility

Oh, Sugar! How Diabetes and Prediabetes Affect Fertility

If you’ve been trying to get pregnant with no luck, it may be time to have a simple blood test to determine if your glucose (blood sugar) levels are high. Over time, persistent high glucose levels may hurt your eyes, kidneys, nerves and heart. It can also lead to infertility. Here’s what you need to know – and what you can do – if you are prediabetic or diabetic and hoping to grow your family.

First, the facts about blood sugar levels.
Diabetes is a very common medical condition today. According to the American Diabetes Association, there are 29 million people in the U.S. living with diabetes. Another 8.1 million people in the country have diabetes, but do not know it.

Type 2 diabetes is the most common form of the disease. If you have Type 2 diabetes, your body does not use insulin properly. This is called insulin resistance. At first, your pancreas makes extra insulin to make up for it. But, over time, it isn’t able to keep up and can’t make enough insulin to keep your blood glucose at normal levels.

Prediabetes is a condition that affects another 79 million Americans. With prediabetes, your glucose levels are higher than they should be—but not high enough to be diagnosed as diabetes. Prediabetes is a wake-up call for diabetes. However, it’s not too late to take actions to lower your risk for diabetes.

Sugar ain’t so sweet when it comes to fertility.
Insulin is a hormone, and when a hormone is out of balance it can cause other hormones – such as estrogen, progesterone and testosterone – to be out of balance, too.

Diabetes alone does not prevent a woman from getting pregnant. In fact, if your diabetes is kept under control through proper diet, exercise and medication, it should not play a major role in your ability to conceive.

However, if your blood glucose levels are not under control, it can have several negative effects on your fertility as well as your ability to sustain a pregnancy. High blood sugar, for example, is a reason why an embryo sometimes fails to implant in the uterus. According to the American Diabetes Association, high glucose levels may increase a woman’s chance of miscarriage by as much as 30 to 60 percent.

Congenital fetal malformations occur more commonly in diabetic mothers with poorly controlled sugar levels. The most commonly affected areas for the fetus are cardiovascular, central nervous system, and genitourinary system. Poorly controlled sugar levels, especially during the third trimester, increase the risk for fetal macrosomia (overly large baby). This can lead to a difficult delivery, birth trauma, and abnormally low glucose levels for the baby after delivery.

Are PCOS and diabetes kissing cousins?
Having too much insulin in the body can increase your risk for PCOS (polycystic ovary syndrome), a condition that affects approximately one in 10 women of childbearing age. Although it is not uncommon to have both diabetes and PCOS, women can have PCOS and not diabetes and vice versa.

Most women with PCOS grow small cysts on their ovaries, thus giving the disorder its name. These cysts are not harmful, but they do lead to changes in the hormonal pathways that produce eggs and prepare the uterus for pregnancy.

For women with PCOS, the ovaries make more androgens (male hormones) than normal. High levels of these hormones affect ovulation and can lead to symptoms like acne, excess body hair, weight gain and “belly fat.”

Among the most important reasons why becoming pregnant – or staying pregnant – may be more challenging for women with PCOS are unreliable, unpredictable or even absent ovulation. Several medications that stimulate ovulation can help women with PCOS to conceive. Another treatment option is in vitro fertilization (IVF), which offers the best chance of becoming pregnant in any given cycle.

In IVF, ovulation is induced with injectable fertility medications so that multiple eggs are produced. Healthy sperm are combined with the eggs in a laboratory. Three to five days after the egg retrieval procedure, the fertilized eggs, or embryos, are then transferred to the uterus through the vagina.

Diabetes may affect a man’s fertility, too.
Recent research indicates that diabetes also can cause fertility issues in men. Scientists have found that DNA damage in the sperm of diabetic men is higher than in the sperm of men who do not have diabetes.

Certain diabetes complications can also contribute to infertility in men. Nerve damage from diabetes can lead to retrograde ejaculation whereby semen goes into the bladder, making it impossible to get to the woman’s reproductive organs. Erectile dysfunction is another diabetes complication that can lead to fertility problems for men.

IVF is an excellent option for many couples who struggle to conceive, due to diabetes, prediabetes and other medical conditions. Sometimes, one sperm may be injected into each egg in a technique called intracytoplasmic sperm injection (ICSI). ICSI is often recommended if there is a problem with sperm quality or quantity. In ICSI, only a single healthy sperm is needed for each egg.

What’s next?
If you have diabetes, talk to your doctor about what you can do to ensure a happy, healthy pregnancy. Keeping your blood sugar levels under control is key to a successful pregnancy.

If you suspect you have prediabetes or PCOS and haven’t been officially diagnosed, visit your doctor again for testing. Couples that have been trying to get pregnant for six months or more should seek the help of a fertility specialist.

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