2021 and especially November marked the 100th anniversary of the discovery of insulin. Insulin transformed diabetes from a fatal disease to a medically manageable chronic condition. Diabetes is a condition where your body can’t keep blood sugar levels in the normal range and doesn’t make enough insulin or can’t effectively use the insulin it makes.
Type 1 diabetes: An autoimmune disease, where the immune system attacks and destroys cells in the pancreas, where insulin is made.
Type 2 diabetes: It occurs when your body becomes resistant to insulin, and sugar builds up in your blood.
Prediabetes: It occurs when your blood sugar is higher than normal, but it’s not high enough for a diagnosis of type 2 diabetes.
Gestational diabetes: Is when you have high blood sugar during pregnancy. Insulin-blocking hormones produced by the placenta cause this type of diabetes.
The most common organs affected by diabetes are the kidneys, the eyes, and the nerves. But what about your reproductive organs and therefore your fertility?
It is often for women with diabetes to experience lower rates of fertility. There are multiple factors associated with diabetes that can make it difficult for women to achieve a pregnancy: obesity, being underweight, having diabetic complications, having Polycystic Ovary Syndrome, or having an autoimmune disease. There are some certain conditions associated with diabetes that lead to reduced fertility rates. One of them is PCOS. Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. The name polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form inside the ovaries. PCOS is largely associated with type 2 diabetes and obesity. The next condition is irregular or absent periods. Many women with diabetes experience irregular periods, which can arrive in cycles of 35 days or more. Some also experience absent periods, which occur when a woman previously had a normal cycle but stopped getting a period for 6 months or longer.
Women with type 1 diabetes are highly likely to experience premature menopause, where their periods stop before the age of 40 years old. The last condition is endometrial cancer, more common in women with type 2 diabetes and PCOS, and this disease can lead to infertility if not treated early on. Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding. If it is discovered early, removing the uterus surgically often cures it. In research conducted in Sweden, around 6000 women with type 1 diabetes were tested and the results showed indeed reduced fertility. But the good news is that their results suggested that the stricter metabolic control exercised in the past 20 years may have helped prevent subfertility.
However, although the risk of congenital malformations has decreased, it is still higher than that for the general population. Previous studies of women with diabetes showed reproductive abnormalities such as delayed menarche and increased incidence of menstrual cycle irregularities and delayed ovulation. With the refinement of insulin therapy, improved fertility might be expected, although fertility among type 1 diabetic women reportedly remained below that for the non-diabetic population in the 1980s. Although the proportions of live newborns with congenital malformations of mothers with type 1 diabetes had decreased for the last 30 years, it was still twice that of the general Swedish female population in most recent years.
The national program for the treatment of diabetes launched in 1990 prescribed that all women who planned to become pregnant were to follow a stricter insulin treatment plan, and this measure may have played a critical role in the improved fertility rates. This research concludes that as time goes by, better glycemic control and prevention of diabetic complications improves all irregularities and increases fertility rates close to those that are seen in the general population.
Diabetes can impact male fertility in many ways, such as erectile dysfunction, which means difficulty in maintaining an erection, with that leading to difficulty for them to conceive without assistance. Ejaculatory dysfunction where the nerve damage caused by diabetes that can cause erectile dysfunction, can lead to a failure of the mechanism that propels sperm forward. This causes either retrograde ejaculation or a complete lack of ejaculation. Finally, semen abnormalities, where men with diabetes are more likely to experience decreased sperm count, poor motility, abnormal sperm shape, and a decrease in sperm DNA integrity. Research studies also show that around 1 in 4 men with type 2 diabetes have low testosterone levels (hypogonadism). There may be a widely held belief that diabetes harms male fertility however, the latest research suggests that diabetes does not affect male fertility as much as was once thought. If men with diabetes receive effective diabetes treatment such as insulin, there is no reason why they should find it more difficult to conceive than other men.
For women with diabetes, if they don’t receive effective diabetes treatment such as insulin intake, there is a greater risk of complications such as nerve damage (neuropathy) and poor wound healing. These problems can make it harder to conceive naturally and increase the need for IVF. The good news for both genders is that nowadays diabetes can be managed to control blood sugar levels.
This involves regular monitoring of blood sugar levels, eating a healthy diet, regular physical activity, maintaining a healthy weight, reducing stress levels, and quitting smoking. So, if you decide to proceed with a pregnancy it is best to do it when your diabetes is well-controlled and no other health issues exist. It is recommended that women with type 1 or type 2 diabetes start taking high dose folic acid (2.5-5mg daily) at least one month before pregnancy and throughout the first trimester. And if you do succeed in pregnancy, regular visits to your doctors are necessary to keep your blood sugar levels in a healthy range.
Once again, the cooperation between patients and doctors is inevitable and fully imperative. Professionals are always there to help you so put your mind at ease and let them take care of you throughout your journey. As we always say, the fertility journey is not a journey you should do alone, and here in MEDIPASS, we will do it together.
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