Diabetes Affects Fertility

Diabetes impacts a significant portion of the Singaporean population, about 1 in 9 adults. However, many are unaware of their condition and its lifelong impact on health, such as blindness, nerve damage, and kidney disease. But it also impacts an aspect of your health that is rarely discussed – your reproductive health.

This condition results from the body's inability to produce sufficient insulin or insulin resistance. Such an imbalance disrupts the physiological processes necessary for producing and carrying eggs or sperm, directly impacting fertility, conception, and embryo implantation[1] [2].

Also, fluctuating blood sugar levels can affect physical and emotional well-being. Poorly controlled diabetes is linked to low sexual desire (libido)[3] in both men and women, which can reduce the frequency of sexual intercourse and complicate the process of conceiving.

Diabetes Affects Female Fertility and Pregnancy

Many factors associated with diabetes can make it difficult for women to achieve pregnancy, such as Polycystic Ovary Syndrome (PCOS) and obesity.

Women with PCOS have cysts (small sacs of fluid) formed around their ovaries, which causes irregular or absent periods and is a common cause of infertility. A significant problem with PCOS is how the body responds properly to insulin - the hormone responsible for regulating blood sugar levels. This reduced insulin sensitivity (or insulin resistance) puts them at higher risk for developing type 2 diabetes over time.

There is also a higher likelihood of developing excess body weight or obesity, as the insulin in the cells does not effectively remove glucose from the blood; the body stores the glucose in tissues as fat, which can cause weight gain.

Many women with diabetes experience irregular periods or miss their periods. [4].

Women with diabetes can conceive naturally, but some may face challenges that lead them to seek in vitro fertilization (IVF) to achieve a successful pregnancy. However, Dr Yeong advises: “We usually like diabetes to be well controlled before embarking on an IVF cycle or embarking on a pregnancy to ensure that the patient is in good health before embarking on a potentially rigorous part of her motherhood journey.”

For women with diabetes, uncontrolled blood sugar levels can pose significant risks during IVF treatment. High blood sugar levels can disrupt the hormonal balance necessary for successful ovulation and a less receptive uterine lining for embryo implantation, all of which can decrease the chances of an IVF pregnancy.

“If the patient is on insulin and has a well-controlled diabetes, there is a better chance at pregnancy,” he added.

While the management and control before an IVF are no different for Type 1 or Type 2 diabetes, Dr. Yeong said more effort and closer management for Type 1 diabetes is required due to the absolute need for insulin.

“For those with Type 1 diabetes, so long as the patient is on insulin and if it's co-managed with an endocrinologist, going through IVF is quite safe,” he advised.

On the risk of gestational diabetes during IVF, Dr Yeong said, “IVF doesn't increase the risk of gestational diabetes, but it is the age of the woman and also her general body mass index (BMI)level.”

“Most IVF patients are above a certain age group; they don't tend to be the younger ones, hence the risk factor of diabetes when they get pregnant. In Singapore, we screen for gestational diabetes as part of the antenatal workup, even in non-IVF patients.”

Diabetes and Male Fertility

For the many Singaporean men living with diabetes, the disease can impact their health in a variety of ways. Not only are they living with a high risk of cardiovascular, renal, and neurologic issues, but they also are more likely to be infertile[5]. Diabetes can impact male fertility in many ways, such as:

• Erectile dysfunction – Diabetes can cause nerve damage, which can lead to difficulty in maintaining an erection, making it difficult for them to conceive without assistance.
• Ejaculatory dysfunction – With erectile dysfunction, it can lead to a failure of the mechanism that propels sperm forward. This causes either retrograde ejaculation or a complete lack of ejaculation.
• Semen abnormalities – Men with diabetes are more likely to experience decreased sperm count, poor motility, abnormal sperm shape, and a decrease in sperm DNA integrity.

A Diabetic-Friendly Diet Consideration when Trying to Conceive 

Couples with diabetes are still capable of conceiving, but before that could happen, maintaining a healthy body weight and keeping their diabetes in check with proper dietary management is crucial.

"Prioritize low Glycemic Index (GI) foods like whole grains; brown or black rice, soba or bee hoon, chapati, legumes; soybean, snow peas, chickpeas, and non-starchy vegetables to maintain steady blood sugar levels," Sarah advised.

"Consumption of high-glycemic Index (GI) foods cause a sharp rise in post-meal blood glucose levels that decline rapidly, whereas consumption of low-GI foods results in a lower blood glucose level that declines gradually," she explained.

GI ranks the number of carbohydrates in foods from zero to 100, indicating how quickly a food raises a person's blood sugar. However, it does not tell you how high the blood sugar will rise after eating it.

"Here is where the glycemic load (GL) comes into play. It gives a more accurate picture of how food affects blood sugar by considering how it is prepared (for example, fried or baked), its fat and fiber content, and the quantity of carbohydrates consumed," she added.

For instance, a serving of 100 grams of plain white rice is considered a high-GI and high-GL food when cooked. You can reduce the GL of rice by limiting the quantity consumed and by adding dietary fiber and protein, e.g., stir-frying veggies and fish or lean meat, to your meal.

If you find that even with maintaining a healthy weight and keeping your diabetes under control, you are unable to conceive after trying for six months if you are over 35 or one year if you are over 30, it may be time to reach out to a fertility specialist for further diagnosis.

Fertility Success with Diabetes Management

Managing diabetes is much needed for couples trying to conceive, as it directly impacts reproductive health and fertility outcomes. In addition to a well-managed lifestyle, including low-GI and nutrient-rich foods, vigilant medical oversight can help improve fertility and overall health.

Diabetes affects both male and female fertility in different ways because high blood sugar affects hormonal balance, which could reduce receptivity for embryo implantation. Conditions such as Polycystic Ovary Syndrome (PCOS), obesity, and irregular periods are common issues in women that could complicate conception. In men, diabetes can lead to complications such as erectile dysfunction, ejaculatory problems, and semen abnormalities. Early consultation with a fertility specialist is recommended to guide conception safely.

[1] Thong EP, Codner E, Laven JSE, Teede H. Diabetes: a metabolic and reproductive disorder in women. Lancet Diabetes Endocrinol. 2020 Feb;8(2):134-149. doi: 10.1016/S2213-8587(19)30345-6. Epub 2019 Oct 18. PMID: 31635966. https://pubmed.ncbi.nlm.nih.gov/31635966/

[2] https://www.cdc.gov/diabetes/risk-factors/diabetes-and-men.html

[3] https://diabetes.org/health-wellness/sexual-health/sex-diabetes

[4] Kwan BS, Kim SC, Jo HC, Baek JC, Park JE. The Association between Menstrual Irregularities and the Risk of Diabetes in Premenopausal and Postmenopausal Women: A Cross-Sectional Study of a Nationally Representative Sample. Healthcare (Basel). 2022 Mar 30;10(4):649. doi: 10.3390/healthcare10040649. PMID: 35455827; PMCID: PMC9032389. https://pmc.ncbi.nlm.nih.gov/articles/PMC9032389/#sec5-healthcare-10-00649

[5] https://lifeprogram.org.au/health-hub/howdiabetesaffectsmalefertility/