Infertility & Pre-Diabetes – What's the Relationship?
What’s coming up in November? It’s Diabetes Awareness Month.
Because of that, we will be dedicating Mondays in November to this topic and how it relates to infertility and fertility treatment. Reproductive Medicine Associates of Connecticut (RMACT) has had its focus on this topic for quite a while. Carolyn Gundell, MS, one of RMACT’s Fertility Nutritionists talked about diabetes and its connection to fertility three years ago in 2012 on PathtoFertility. In case you haven’t had a chance to read her thoughtful piece, here it is again.
Best thing about Carolyn’s piece? How hopeful it is. And how she explains things in a way that is manageable and accessible to a non-clinical person reading it.
Diabetes & Trying to Conceive
Pre-diabetes and diabetes are conditions that do need to be examined if you are trying to conceive. Isn’t it a relief to know that there are programs in place, led by qualified, knowledgeable and passionate professionals that can turn a situation around so that it’s safe and effective to try to become and stay pregnant?
Think of this as a preview for November. You will hear more from Carolyn Gundell, MS, Dr. Spencer Richlin, (RMACT’s Surgical Director and lead physician for the Diabetes Program), Melissa Kelleher, LCSW (one of RMACT’s Fertility Counselors) and more.
Do you have questions about why this is an important subject? Or how it could affect you?
Please let us know. We’re happy to find the right person to answer your questions. When it comes to pre-diabetes and diabetes, we have made sure that we have the right professionals to help with these serious, but manageable problems. ~Lisa Rosenthal
Diabetes & Fertility | Misconceptions and Truths
Written & compiled by Carolyn Gundell, MS
November is Diabetes Awareness Month. As I think about this, I recall many patients who I have counseled through ourNutrition Program for pre-diabetic and diabetic conditions. I remember their disappointment as we discussed that their fertility “treatment” would be at a short-term pause until their blood sugar numbers lowered to safer levels. As a Nutritionist providing direct care to fertility patients, I do know how difficult it is for a patient and her partner to take extra time to optimize their health. I also know that diabetes risk can be lowered with simple lifestyle changes. I have seen couples improve their health, lower glucose levels within 2-3 months and move forward to become pregnant. Disappointment turned to hope.
Myth: Diabetes is not that serious of a disease.
Diabetes is occurring in the U.S. in epidemic proportions and is a real health threat. Data from the 2011 National Diabetes Fact Sheet estimate 26 million U.S. children and adults have diabetes. What I find even more alarming—7 million American have no idea they have diabetes and 79 million have pre-diabetes. Diabetes is increasingly diagnosed in women and men in their childbearing years. In the 20 yrs and older age group, a total of 1.9 million new cases of diabetes were diagnosed in 2010. Of this 1.9 million, 465,000 individuals aged 20-45yrs old were newly diagnosed.
Considering the rise in diabetes, it is not surprising that there has also been a considerable rise in diabetes diagnosed first in pregnancy--gestational diabetes. With the use of new diagnostic criteria for gestational diabetes, it is estimated that 18% of pregnancies are affected by gestational diabetes. Women who have had gestational diabetes have a 35-60% chance of developing type 2 diabetes in 10-20 years. Immediately after pregnancy, 5-10% of women with gestational diabetes are found to have type 2 diabetes. Children affected by elevated glucose levels in utero are at increased risk for diabetes themselves.
FACT: RMACT screens all women for diabetes or pre-diabetes?
Yes we do! We test Hemoglobin A1c (HgbA1c) on every new patient. This blood test indicates how well blood glucose has been controlled over the past 2-3 months. The higher glucose concentration is in the blood, the higher the level of HgbA1c. Ideal HgbA1c range is 4.8-5.5. All RMA of CT patients with a HgbA1c of > 5.7 will go for further testing and are referred to me for nutrition and lifestyle counseling. All patients with HgbA1c > 6.0 are informed that fertility treatment needs to be on hold until their HgbA1c is < 6.0.
FACT: Pre-diabetes and diabetes can affect fertility in both men and women.
In women, elevated blood sugar levels and insulin resistance can complicate ovulation and make menstrual cycles unpredictable. The American Diabetes Association reports that high glucose levels increase a woman’s chance of early pregnancy miscarriage by 30-60%. This means that high glucose levels can prevent the embryo from implanting in the uterus before a woman realizes that she is even pregnant. Elevated glucose can also negatively affect estrogen, progesterone and testosterone levels—all of which are important for pregnancy to occur and be sustained until delivery. In men with pre-diabetes or diabetes, high glucose levels may contribute to erectile dysfunction and damage to sperm DNA. Damage to the DNA could result in miscarriage and birth defects.
FACT: Abnormal glucose levels can cause health concerns for both mother and baby.
Diabetes (type 1, type 2, gestational) can affect the health of both the mother and her unborn child. Poor blood sugar control during pregnancy increases risk for miscarriage, birth defects and other serious problems. Uncontrolled gestational diabetes leads to increased risk for an extra large baby, c-section, pre-eclampsia and hypoglycemia in the newborn. The truth is that many years ago women with uncontrolled blood sugar or diabetes were told that it would not be safe to be pregnant, but now with medical support and monitoring blood glucose levels within safe range, having a healthy child is possible.
MYTH: If I have a high risk for diabetes, there is nothing I can do to prevent it.
Diabetes is NOT your destiny! While understanding that it is very important to lower glucose levels to improve fertilityand reduce risks to the mother and her unborn child is highly important, it is ALSO important to understand that controlling glucose levels and getting them to a more normal level is ABSOLUTELY POSSIBLE and will reduce risks, open the door for a safe pregnancy resulting in a healthy child. All men and women can reduce their risk for diabetes by getting medical guidance and making the following lifestyle modifications:
- Lose 10% of body weight
- Participate in daily 30-60 minutes of physical activity
- Follow healthy dietary recommendations:
- Low in saturated fats, Choose lean meats/fish & low-fat dairy
- Choose high fiber, fresh vegetables, fresh fruits, heart healthy fats
- Choose complex carbohydrates/whole grains
- Avoid processed carbohydrates, low added sugars, limit sweets
- Limit high fat foods
- No smoking
- Do not skip meals
- Practice stress management
- Get quality sleep
After all, shouldn’t the preconception period be the time when a woman optimizes her health and in turn creates a welcoming environment for fertilization and fetal growth? This is what the science is telling us. Start with small, simple, consistent changes mixed with self-compassion and the change you are looking for will happen.
About Lisa Rosenthal
Lisa has over thirty years of experience in the fertility field. After her personal infertility journey, she felt dissatisfied with the lack of comprehensive services available to support her. She was determined to help others undergoing fertility treatment. Lisa has been with RMACT for eleven years and serves as Patient Advocate and the Strategic Content Lead.
Lisa is the teacher and founder of Fertile Yoga, a program designed to support men and women on their quest for their families through gentle movement and meditation.
Lisa’s true passion is supporting patients getting into treatment, being able to stay in treatment and staying whole and complete throughout the process. Lisa is also a Certified Grief Recovery Specialist, which is helpful in her work with fertility patients.
Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association (now Path2Parenthood), where she was Educational Coordinator, Conference Director and Assistant Executive Director.