Diabetes and Infertility: When Blood Sugar Control Isn’t Enough

An excerpt from the book, Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby.

Maybe your blood sugars have been great and you’ve been having ongoing sex with your partner. But if you’re still not pregnant after six to twelve months of trying, you’re considered infertile. Dealing with infertility and diabetes can feel like an energy-draining double whammy of health issues, but you’re not alone. There’s a definite group of women with diabetes who require even more maintenance and medical specialists to figure out why, once again, their bodies aren’t doing what seems to come naturally for everyone else.

What’s Going On?

Infertility is an inability to get pregnant. You are considered infertile after a year of actively trying to conceive (i.e., having unprotected sex around the time you ovulate) if you are younger than 35, and after six months if you’re 35 or older, or if you have a history of many miscarriages. The timeframe is key: It can take some fertile couples that long to conceive naturally, while older women are advised to seek help sooner since fertility declines rapidly with age. About 10 to 15 percent of all couples experience infertility. Of those, about 40 to 50 percent are caused by female infertility, while another 30 to 40 percent are caused by male infertility. The rest are either a combination of male and female factors, or are simply unexplained as one of life’s many mysteries.

Several factors can lead to infertility, according to the national infertility association RESOLVE: age, weight, sexually transmitted diseases (STDs), Fallopian tube disease, endometriosis, exposure to a chemical known as Diethylstilbestrol (DES), smoking, and alcohol use.

Diabetes and Infertility: Are They Related?

While all the above are general causes for infertility, what’s going on when you have diabetes? According to Dr. Carol Levy, M.D., CDE, senior medical director of endocrinology for Novo Nordisk and an endocrinologist who saw more than 600 diabetes and pregnancy patients at Weill-Cornell Medical Center over an eight year period, type 1 or type 2 may have an indirect role. “Poor glucose control may create an environment where someone might not get pregnant because the body doesn’t view the environment as appropriate for becoming pregnant,” she said. Because conception requires specific timing, eggs being released, sperm being hardy, and your body being hospitable to nurturing for the next forty or so weeks, if something in your chemistry isn’t exactly right, you may have a tougher time procreating.

Then again, despite the potential risks of doing so, plenty of women with high HbA1cs get pregnant—so blood sugars aren’t the only factor when it comes to figuring out why you’re not yet knocked up. Type 1 women who develop diabetes because of the body’s autoimmune response can be prone to developing other disorders such as thyroid disease or autoimmune premature ovarian failure. The body, similarly to what happens with type 1 diabetes, might decide to wrongly attack healthy cells that maintain thyroid hormones or ovarian function—both of which play a role in getting pregnant. Talk to your doctor about checking your thyroid levels and ovarian function, particularly your TSH (thyroid stimulating hormone) and your FSH (follicle stimulating hormone). The TSH level should be checked before trying to conceive, but definitely look into both your TSH a second time and your FSH levels if you’re having problems after trying and not succeeding.

Another below-the-belt issue comes from Polycystic Ovarian Syndrome (PCOS), or having polycystic ovaries. This is common with type 2 women and appears in some type 1s. With PCOS, the follicles on the ovaries, which typically release eggs when you ovulate, instead form cysts or lumps. These cysts don’t break open, the eggs are trapped inside, and ovulation doesn’t happen. Without ovulating, there’s no egg to fertilize. Coupled with an irregular or missing period, PCOS puts a serious damper on your efforts to conceive. The condition can be treated with medication that enhances ovulation or makes you more sensitive to insulin, as insulin resistance often accompanies PCOS.

Extra pounds can affect your efforts to get pregnant, too. “Type 2 diabetes has a higher association with obesity, and obesity has an association with sub-fertility or infertility as it affects ovarian function,” said Dr. Tamara Takoudes, M.D., co-director of the Joslin-Beth Israel Deaconess Medical Center Diabetes and Pregnancy program in Boston, Massachusetts. “For example, when obese women lose weight, they ovulate more predictably.”