At a Glance:

Yes, diabetes is known to affect your ability to get pregnant and successfully have a baby. Diabetes is known to affect fertility and reproductive health in both men and women. Diabetes can cause hormonal disruptions which in turn can lead to delayed or failed implantation and/or conception. Also, diabetes is associated with poor quality of sperm and embryo, and DNA damage (genetic mutations and deletions).

Glucose is an essential source of energy for the body. Usually, glucose requirements and blood glucose levels are well managed by insulin, a glucose absorbing hormone produced by the pancreas. When glucose utilization is successfully managed, the body glucose levels remain in safe range. Otherwise, the person may notice signs or symptoms of impaired glucose tolerance or diabetes.

Diabetes is a condition wherein the pancreas does not make enough insulin (Type I diabetes), if at all, or the insulin that is produced does not work as it should (Type 2 diabetes). The WHO estimates that more than 180 million people worldwide have diabetes.  Type 1 diabetes is rising alarmingly worldwide, at a rate of 3% per year.

Effect of diabetes on fertility

Diabetes and female infertility:

Systematic studies of the metabolic effects of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) on the hypothalamus–pituitary–ovary (HPO) axis have revealed a relationship between these diseases and menstrual disturbances, such as delayed menarche (puberty), alterations in the menstrual rhythm (including primary and secondary amenorrhoea) and potential consequences on fertility (successful conception) and fecundity (successful full-term gestation and childbirth).

How does diabetes affect fertility?

Genitourinary infections: Diabetic women are more susceptible to infection and damage to reproductive organs, especially, fallopian tubes.

Pregnancy complications: High blood glucose levels can cause miscarriage or congenital defects in the fetus. Increased blood glucose and excessive nutrition for the growing fetus result in macrosomia (big baby syndrome).

Decreased libido: Because of tiredness, depression and anxiety most diabetic women have decreased sexual desire. Due to less vaginal lubrication, women may experience pain and discomfort during sex.

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How does type 1 diabetes affect female fertility?

Menarche & menstrual cycle disturbances: Type 1 diabetes is associated with longer cycle length (>31 days), longer menstruation (≥6 days), heavy menstruation, and menstrual problems at a younger age (<29 years). Juvenile diabetes (type 1) causes delayed menarche.

Anovulation: Anovulation is the absence of ovulation when it would be normally expected (in a post-menarche, premenopausal woman). Anovulation can result from a variety of factors such as chronic mental illness, hormone imbalances, pituitary or ovarian failure or diabetes. Low BMI, diabetic women will have irregular periods, which causes starving of cells (intracellular starvation). This may cause disruption in the hypothalamic pulsatile secretion of the gonadotropin-releasing hormone (GnRH), with a resultant decrease in the secretion of gonadotropins. This results in a lower level of luteinizing hormone (LH) and prolactin which plays an active role in reproduction.

Anti-sperm antibodies: The antibodies produced in diabetes can attack the sperms and her eggs.

How does type 2 diabetes affect female fertility?

Diabetes, obesity and PCOS: Generally, Type 2 diabetes occurs in postmenopausal women, but with modern dietary and lifestyle patterns, obesity is on a high, thus raising the incidence of Type 2 diabetes during the reproductive years.

Obesity is associated with irregular menstrual cycles and also linked to PolyCystic Ovarian Syndrome (PCOS). It is a metabolic disorder and characterized by an excess of androgens (male hormones), cysts on the ovaries and irregular menstrual cycles/lack of ovulation. Between 50-70% of women who have PCOS also have insulin resistance.

Adiponectin is a hormone that improves insulin sensitivity and prevents obesity. In women with PCOS, lower levels of adiponectin lead to poor sensitivity to insulin and fat breakdown. Thus, PCOS coexists with diabetes and obesity; this is a triple threat to fertility and reproductive health.

Losing weight with a healthy diet and exercise is the most effective way to correct insulin resistance, increase fertility and prevent Type 2 diabetes and the resulting complications.

In women, diabetes coexists with obesity, PCOS and affects fertility

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Diabetes and male infertility:

How does diabetes affect male fertility?

Sexual dysfunction: Diabetes reduces the ability to maintain an erection in men, which leads to infertility.

Decreased libido: Lack of glucose (only source of energy for the brain) in certain areas of the brain may cause fatigue, weakness and less sexual drive in men.

How does type 1 diabetes affect male fertility?

Sperm DNA damage: Diabetes is associated with increased nuclear, mitochondrial and DNA damage that may impair the reproductive capability of men.

How does type 2 diabetes affect male fertility?

Sperm quality: Type 2 diabetes is associated with poor sperm concentration in semen, and motility. Also, structural damage to the sperm and its DNA are noted in type 2 diabetics.

Treating diabetes and infertility together:

For both men and women, treating infertility with diabetes involves enhanced control over blood sugars (glycemic control), reproductive hormones and functions. Diagnosis and treatment of infertility usually involves the study of medical history and family history of the couple together.

What are the different treatment options for diabetes?

Your endocrinologist may suggest treatment options such as oral medications and/or insulin. Sometimes, associated treatment options like weight loss surgery, may also be advised.

What are the different treatment options for infertility?

Treatment for infertility in men and women

Medications and Advanced Reproductive Technologies (ART) are used to overcome problems of infertility and successfully have a baby.

Medical management: Infertility treatments may begin with medications to stimulate ovulation in women, treat infections, and sexual intercourse problems such as erectile dysfunction and premature ejaculation in men. Treatments may or may not include hormonal supplements.

Surgical management: In many cases of PCOS, uterine fibroids, traumatic injuries, surgical management is essential.

Advanced reproductive technologies

• For men: Sperm retrieval procedures (such as microTESE) and intracytoplasmic sperm injection.
• For women: Intrauterine insemination, assisted laser hatching and in vitro fertilization.

Pregnancy with diabetes is a possibility, it only requires a good head start and planning. A team of endocrinologist, gynecologist, and andrologist ensure that your blood sugar levels are in ideal range to facilitate conception and maintain pregnancy till full-term. The key to success is to understand and reduce the risks involved, eating right, work on ideal weight, and follow the instructions of your healthcare team.

If you are diabetic and are trying unsuccessfully to have a baby, it is important to let your endocrinologist know. Sometimes, you may also need help from a fertility expert.