The Diabetes-Infertility Connection
By Jami Kupperman, NMD
Most of us have heard the risks of having diabetes during pregnancy. Uncontrolled diabetes during pregnancy can cause problems for both mother and baby. The mother may develop high blood pressure, which can in turn increase the risk of premature delivery, and even seizure and stroke in the mom. If the baby is born prematurely, it might have breathing problems, heart problems, bleeding into the brain, intestinal problems, and vision problems. Uncontrolled diabetes during pregnancy may cause the baby to develop a condition called macrosomia, which means an “extra large” baby, which not only can lead to difficulties during delivery and may necessitate a cesarean section (c-section), but can also increase the risk of a stillbirth. These are all frightening scenarios, yet with proper diagnosis and management they can be minimized. But can having diabetes actually hinder your chances of getting pregnant? The answer is…maybe.
In order to understand the possible connection between diabetes and infertility, we must start with understanding insulin resistance. Insulin is the hormone produced by the pancreas to help us utilize glucose (blood sugar), our major fuel source. In type 2 diabetes, the most common type of diabetes, the body produces insulin, but the rest of the tissues in the body are resistant, or not as responsive, to insulin as they should be. This means that we cannot effectively utilize glucose, and thus starts the cycle of all the problems we’ve heard about that are associated with diabetes. Before we are diagnosed with full-blown type 2 diabetes, this process of insulin resistance has been going on for many years.
This leads us to discuss a separate, and seemingly unrelated condition known as polycystic ovarian syndrome (PCOS). This is another endocrine (hormone) problem, which can be associated with menstrual irregularities such as absent or infrequent periods, hyperandrogenism which can cause acne and hirsutism (excessive hair growth), obesity, and as the name of the syndrome implies, multiple cysts on the ovaries. In addition to other possible signs and symptoms, PCOS is the number one hormonal cause of infertility.
While many of the signs and symptoms of PCOS are commonly managed (although not cured) with oral contraceptive pills, which reduce acne and hirsutism and artificially regulate menstrual periods, recently more attention has been given to managing one of the potential underlying causes of PCOS—insulin resistance. That’s right, many women with PCOS exhibit signs of insulin resistance, and have an increased risk of developing overt diabetes.
So now we have discovered the possible connection between infertility and diabetes, and that connection is PCOS. Many women with PCOS are now being treated with a common diabetes medication called metformin. One of metformin’s mechanism of actions is to increase peripheral insulin sensitivity, thereby decreasing insulin resistance. In fact, solely treating with metformin has been shown to restore regular menstrual periods, thereby increasing potential fertility!
This deepened understanding of PCOS presents exciting possibilities in the field of naturopathic medicine. While there are studies utilizing naturopathic therapies in insulin resistance and diabetes, there have not yet been any studies specifically exploring naturopathic interventions for targeting insulin resistance in the presence of PCOS. At the very least, this understanding warrants a discussion with your naturopathic physician about the possibility of including such therapies in the treatment and management of PCOS. Both conditions, insulin resistance and PCOS, carry with them risks of many medical and psychosocial burdens, and should be taken seriously by both you and your physician. Any interventions with the potential to reduce those burdens are worth further exploration.
