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Common Diabetes Complications: Diabetes & Infertility



Infertility, the inability to become pregnant within 12 months of trying to conceive, affects about 10% of the population. There are no barriers to infertility: It affects all socioeconomic levels, racial, ethnic and religious groups. Because infertility knows no boundaries, there’s a good chance that your friend, relative, coworker, neighbor - or even you – maybe coping with the medical and emotional aspects of infertility.

The good news is that in the majority of cases, there is a specific medical cause for infertility that can be resolved. In fact, only about 10% of infertility cases go unexplained.

In most instances, simple lifestyle changes like weight loss through proper exercise and nutrition, can help reverse the affects of infertility. However, diseases like diabetes can cause extra complications for both women and men when it comes to fertility.

To help explain diabetes complications in relation to female infertility and male infertility, we turned to a specialist for help - a physician well-versed in obstetrics, gynecology and reproductive endocrinology - Dr. Tommaso Falcone.

The Causes of Infertility

According to Dr. Tommaso Falcone, Professor and Chairman of the Department of Obstetrics-Gynecology at the Cleveland Clinic, diabetes and insulin-related infertility are quite common.

Think of it this way: Insulin is a hormone. So when you have diabetes, or any form of insulin resistance, you have a hormone imbalance. When one hormone is out of balance, it can trigger a domino-like effect with the rest of your hormones, including estrogen, progesterone and testosterone levels. These hormone imbalances can cause a wide variety of side effects, ranging from ovarian cysts to erectile dysfunction and infertility.

“Exercise programs, vitamin supplements and weight loss alone will result in ovulation about one-third of the time. When Clomiphene Citrate, Metformin and Letrozole are used to treat the remainder of infertility patients*, in the end, more than 80% of infertile couples are able to conceive, if there are no other infertility problems.”

Fortunately, Dr. Falcone says that most cases of infertility, whether they are related to diabetes complications or not, can be treated. In cases where infertility is related to insulin levels, correcting the imbalance is often enough to result in a successful pregnancy.

Female Infertility & Diabetes

DCS: Due to the growing epidemic of diabetes, are you seeing more cases of diabetes-related infertility?

Dr. Falcone: Not necessarily. However, obesity and insulin resistance are two of the most common factors that lead to infertility, especially female infertility. We are seeing more patients diagnosed with Polycystic Ovarian Syndrome (PCOS) and Dysmetabolic Syndrome X, which affects about 25% of the population. In fact, PCOS is known to be one of the most common causes of female infertility. These disorders are similar in that insulin-resistance, which can causes infertility, is a key factor. Both are associated with obesity and eventually, diabetes.

FACT: Insulin resistance is found in up to 60% of obese women and 40% of non-obese women. One-third or more of women with PCOS experience some degree of infertility, but the incidence may be lower in non-obese women. Anovulation (failure to ovulate) is the cause for about 25% of female infertility cases, with PCOS being the most common cause of anovulation. This means that PCOS could be a factor in about one-fifth of all infertility cases. Of the people diagnosed with Type 2 diabetes, 80% to 90% are also diagnosed as obese. This fact provides an interesting clue to the link between diabetes and obesity.

DCS: Let’s say that you are a female and have diabetes. You may or may not have female infertility, but you do want to become pregnant. What can you do to improve the chances?

Dr. Falcone: If you want to be pregnant, you need perfect control of your blood sugar. This means you need to watch your insulin, HgbA1c and hemoglobin levels, as well as your weight. Whether you have diabetes or not, watching what you eat, exercising properly and ensuring adequate nutrition with a vitamin supplement will improve your chances of conception.

Male Infertility & Diabetes

DCS: What about diabetes and infertility as it is related to males? Does it cause fertility issues in men, too?

Dr. Falcone: Yes. Certain diabetes complications can cause issues for men that contribute to infertility. For example, nerve damage from diabetes, multiple sclerosis or a spinal cord injury can lead to retrograde ejaculation – where the semen goes into the bladder. Since the semen never reaches the female reproductive system, infertility may be an issue. Erectile dysfunction, or the inability to achieve an erection, is another diabetes complication that can lead to fertility problems for men.

FACT: In about 35% of infertility cases among couples, the male is diagnosed as being infertile with about 20% of cases affecting both partners. Furthermore, a preliminary report conducted in May 2007 by researchers in Belfast, Northern Ireland, showed that men with Type 1 diabetes may have DNA damage in their sperm, possibly hampering fertility.

Diabetes & Infertility Treatments: What’s New?

DCS: Are there any new ways to treat infertility caused by diabetes complications?

Dr. Falcone: Well, we’re seeing some early success in morbidly obese women undergoing bariatric or gastric bypass surgery (for weight loss). As they shed pounds, one side effect is that they may be able to conceive, when they were previously unable to. Of course, this procedure is extreme in terms of fertility treatments, but it does illustrate the strong link between obesity and infertility.

Diabetes Complications in Relation to Pregnancy

DCS: So, let’s move past infertility and say a couple is able to become pregnant. If the woman has diabetes, are there any known diabetes complications that put her or the baby at risk?

Dr. Falcone: The main diabetes complication, including gestational diabetes, related to pregnancy is macrosomia – or a big baby (higher than the 90th percentile in birth weight). Sometimes these babies are not able to pass through the birth canal, so there are higher incidences of cesarean sections, and sometimes it’s necessary to induce labor early. Fetal distress can also become an issue. And there is an increased risk of birth defects. This condition is directly related to maternal diabetes problems, especially during the first few weeks when a woman may be unaware she is pregnant. For this reason, women with diabetes should plan ahead and get their insulin levels under control before attempting to conceive.

The Psychological Effect of Diabetes & Infertility

The inability to conceive and bear children can be a major life crisis. After months and months of trying to conceive, a couple may feel like their entire life is on hold. They may also become depressed due to chronic disappointment, feeling that their bodies are not behaving as expected. Relationships often become strained.

To make the situation worse, infertility is hidden in society. It’s an extremely private topic, rarely discussed openly at work or even in casual conversation. And unfortunately, the physical problem of infertility often causes psychological effects, such as:

  • Loss of the pregnancy, birth, parenting, and even grand-parenting, experience

  • Loss of a sense of spirituality and sense of hope for the future

  • Loss of work productivity

  • Loss of feelings of self-worth

  • Loss of your legacy and family genetics

  • Loss of stability in family and personal relationships


  • If you, or someone you know, suffers from diabetes and infertility, let them know there is hope. More than 80% of all infertility cases are treatable – and almost one-third don’t require treatment other than what you can do for yourself: a healthy diet and proper exercise. Learn more about maintaining proper blood glucose levels, shopping for diabetes testing supplies, and choosing the best diabetes supplies at Diabetic Care Services. Visit the Center for Reproductive Medicine for more information about diabetes, infertility and to find out how Dr. Falcone and the Cleveland Clinic can help you.

    About Tommaso Falcone, M.D., FRCS(C), FACOG

    Diabetes and Infertility

    Tommaso Falcone, M.D., FRCS(C), FACOG, is the Professor and Chairman of the Department of Obstetrics-Gynecology at the Cleveland Clinic and is Director of the Reproductive Endocrinology Research Laboratory.

    Dr. Falcone received his medical degree from McGill University School of Medicine in Montreal, Quebec, Canada in 1981.


    While at McGill, he went on to complete a residency in obstetrics and gynecology and a fellowship in reproductive endocrinology.

    Dr. Falcone served as Associate Professor of Obstetrics and Gynecology at McGill before coming to the Cleveland Clinic in 1995, as Head of the Section of Reproductive Endocrinology and Infertility.

    Dr. Falcone is certified by the American Board of Obstetrics and Gynecology in general obstetrics and gynecology, as well as reproductive endocrinology. He is also certified by the Royal College of Physicians and Surgeons of Canada.

    Dr. Falcone has published more than 200 scientific papers, abstracts, and book chapters. He is co-author of a laparoscopic surgery atlas and is an ad hoc reviewer of many journals. He serves on the editorial board of the Journal of Gynecologic Surgery and Fertility & Sterility. His primary research interests include endometriosis (including the role of oxidative stress and treatment modalities) and basic and clinical research in fertility and assisted reproductive technology.

    *Note: Induction of ovulation with Metformin and Letrozole are off-label uses of the drugs

    References:

    Resolve: The National Infertility Association – www.resolve.org
    Fertility Neighborhood – www.fertilityneighborhood.com
    MediFocus Guide to Polycystic Ovarian Syndrome – www.medifocus.com
    WebMD – www.webmd.com



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