A common question that I receive on Instagram and from clients alike, is how does having diabetes and high blood glucose levels affect fertility?
Well, I called in my fellow fertility and prenatal dietitian & nutritionist, Larissa Telfer, who is also a Credentialed Diabetes Educator, to answer this question in this article.
Read on to find out more about how diabetes affects fertility for both men and women.
But first of all…
What is diabetes?
Diabetes is a chronic medical condition where the body’s ability to produce or respond to insulin is impaired, resulting in high blood glucose levels. The reasons why an individual develops diabetes are complex and vary depending on the type of diabetes. The 3 main types of diabetes are:
- Type 1 diabetes – an autoimmune condition where your immune system destroys the insulin producing cells in the pancreas, insulin is required for survival as the pancreas no longer produces insulin. The exact cause of type 1 diabetes is unknown, whilst people with type 1 diabetes are generally diagnosed in childhood and adolescence, it can develop at any life stage.
- Type 2 diabetes – a progressive condition driven by insulin resistance, meaning the cells in our body become resistant to the insulin produced by the pancreas. Overstimulation of the pancreas to produce more insulin results in gradual decline in insulin production. Factors that increase your risk of type 2 diabetes include a family history, carrying extra weight, women who have had Gestational Diabetes (for example with a previous pregnancy) or PCOS.
- Gestational Diabetes (GD) – a temporary type of diabetes that develops in pregnancy due to the placental hormones that cause insulin resistance, in the later stages of pregnancy a woman’s insulin requirements are 2-3 times higher than when not pregnant. GD is the fastest growing type of diabetes in Australia, women who have had GD are 7 times more likely to develop type 2 diabetes later in life.
Women are at risk of Gestational Diabetes if they have a family history of type 2 diabetes, higher body weight pre-pregnancy or excessive weight gain in early pregnancy, previous GD, PCOS, previous large babies (over 4.5 kg), age over 40 and certain ethnic backgrounds may be at increased risk too.
Speak to your doctor about earlier screening in your pregnancy for gestational diabetes if you have one or more of these risk factors.
How does diabetes affect female fertility?
Diabetes can impact female fertility depending on the type of diabetes.
Type 1 Diabetes & Female Fertility
Fertility issues can occur in women with type 1 diabetes due to general dysfunction in hormonal control responsible for stimulating menstrual cycles, animal studies have shown an adverse impact of egg quality. Sub-optimal blood glucose control at time of conception and in early pregnancy increases risk of pregnancy loss and congenital abnormalities.
Advancements in technology and medical treatments of type 1 diabetes have led to reduced occurrence of these outcomes, as optimising blood sugar levels prior to conception reduces the risk of any adverse outcomes. This is why it is so important to work with a dietitian, diabetes educator and endocrinologist when planning your pregnancy!
Type 2 Diabetes & Female Fertility
Fertility issues in women with type 2 diabetes can result due to a number of factors, for example PCOS and high body weight are risk factors for type 2 diabetes and can lead to fertility issues on their own. As with type 1 diabetes, blood sugar levels leading up to conception and in early pregnancy can impact egg health, and risk of congenital abnormalities and pregnancy loss.
For women who are at risk of type 2 diabetes such as those with a family history, PCOS or GD in previous pregnancies, it is important to have screening with your doctor as people with early stages of type 2 diabetes generally don’t experience any signs or symptoms.
How does diabetes affect male fertility?
Diabetes can impact male fertility particularly if blood sugars are high or poorly managed leading into conception. The way in which diabetes impacts male fertility depends on the type of diabetes.
For men with type 1 diabetes sub-optimal control can impact sperm volume and motility, whereas type 2 diabetes is driven by inflammation which leads to changes in sperm DNA and vitality. Erectile dysfunction is a complication for men with diabetes long term or those with sub-optimal blood glucose control.
Why is your diet critical in managing diabetes and enhancing your fertility?
Optimising blood sugars leading when planning pregnancy reduces the risk of fertility issues and complications. For people with diabetes this is a critical time to engage with their diabetes team including an endocrinologist, diabetes educator and dietitian.
For people with diabetes what you eat impacts blood sugars and understanding how food impacts blood sugars is a key part of managing diabetes.
Working with a dietitian who understands diabetes and has a special interest in fertility nutrition will provide you with a plan tailored to your individual needs and diabetes.
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