Does diabetes mellitus affect fertility and pregnancy?

By (gynecologist), (gynecologist), (embryologist) and .
Last Update: 02/13/2023

Diabetes milletus is a long-term, i.e. chronic, metabolic disease characterized by elevated blood glucose levels. By having a high amount of sugar in the blood, it is possible that it can lead to health problems in patients, whether in the heart, eyesight, kidneys, etc. In addition, diabetes is associated with fertility problems and pregnancy.

There are many doubts that a diabetic woman may have when facing pregnancy. Many wonder if it will be dangerous for the baby or for themselves, if there is a way to avoid the complications that may be associated, etc.

However, diabetes not only affects women's fertility, but this pathology also has effects on men's fertility.

What is diabetes mellitus?

Diabetes is a pathology that arises from the presence of high blood sugar levels. This disease is of long duration, so it is considered a chronic condition.

Blood glucose levels considered normal are between 70-130 mg/dL fasting; whereas after meals, glucose concentrations below 180 mg/dL would be normal. However, in pregnant women, it is usual to have 95 mg/dL before eating and 140 mg/dL or less one hour after the meal. However, glucose levels may vary from person to person.

There are several types of diabetes depending on the cause:

Type 1 diabetes
caused by a lack of insulin production due to the destruction of pancreatic cells by the immune system.
Type 2 diabetes
the cause of this type of diabetes is the misuse of insulin, so that blood glucose levels are not regulated.
Gestational diabetes
appears during pregnancy, but usually subsides after delivery.

In short, people suffering from diabetes do not generate a sufficient amount of insulin or do not use it properly, resulting in the accumulation of glucose in the blood, leading to serious health problems.

How does diabetes affect fertility?

Type 1 and 2 diabetes can interfere with both male and female fertility. If blood glucose levels are not properly controlled, they can cause a decrease in the pregnancy rate. Occasionally, patients with diabetes must resort to assisted reproduction techniques to fulfill their reproductive desire. The effects of diabetes on reproductive capacity are detailed below.

Diabetes and fertility in women

Female fertility may be impaired in women who have diabetes and their blood glucose levels are not adequately controlled.

If there is a situation of hyperglycemia, i.e. high levels of glucose in the bloodstream, it is possible that an adequate amount of other hormones such as estradiol, progesterone or testosterone may not be generated. These hormones are essential if pregnancy is to be achieved. Therefore, if there is an imbalance in hormone production caused by hyperglycemia, the woman will have difficulty getting pregnant.

In addition, diabetes is also related to menstrual imbalances, polycystic ovaries, amenorrhea or early menopause, among other situations.

Another problem associated with poorly treated diabetes and female infertility is obesity. Women with a high body mass index (BMI) will have altered leptin levels and, as a consequence, will influence embryo implantation.

Diabetes and fertility in men

As in women, men who suffer from uncontrolled diabetes may also have fertility problems. The quality and quantity of semen in men with diabetes decreases because it usually causes damage to the testicles, where sperm are produced and mature.

Among the main effects caused by diabetes on male fertility are the following:

  • Genetic alterations of sperm DNA: the percentage of sperm fragmentation in men with diabetes is higher than in the general population according to several studies.
  • Fertilization failure: diabetic men are not able to repair damage to sperm genes, which often leads to problems in conception.
  • Premature aging of spermatozoa: if there is a high amount of reactive oxygen species (ROS) in the male reproductive tract it will cause high oxidative stress.

In addition to these effects of diabetes on male fertility, male sexual function may also be compromised. For example, there are cases of men with diabetes who present erectile dysfunction or ejaculation alterations such as retrograde ejaculation, for example. Therefore, sexual dysfunction would also cause difficulty in achieving pregnancy in the male.

Risks of pregnancy with diabetes

Pregnancy in a woman with diabetes is considered a high-risk pregnancy since this gestational situation may pose a danger to both mother and baby. During pregnancy, the mother's body needs an increase in nutritional intake, so the metabolism has to adapt to this new situation.

One of the changes that occurs is an increase in glucose utilization, so the mother will need to increase the amount of insulin. This aspect is very important since the mother will have to adapt her diabetes control to the new conditions of pregnancy. This means that the pregnant woman will have to modify her meal plan, physical activity routine and medication.

The perfect situation would be for the woman with diabetes to control her blood glucose level prior to pregnancy. This is essential because high glucose levels can harm the baby during the first weeks of pregnancy, even before you know you are pregnant.

In order to be able to cope with pregnancy without problems, glycemic control must be carried out throughout pregnancy, which involves particularly careful monitoring of blood glucose and precise medical control.

Consequences of pregnancy in diabetic women

Women who wish to become mothers and suffer from diabetes should follow all medical indications to avoid endangering their health and that of the baby. However, if the woman is not properly treated, pregnancy in diabetic women can lead to complications:

  • Increased risk of pregnancy hypertension.
  • Hypoglycemia or low blood sugar.
  • Renal, cardiac or other organ alterations.

Similarly, the baby may also present complications associated with blood sugar imbalance, especially in the first trimester of life:

  • Congenital malformations or defects.
  • Increased risk of macrosomia (larger than normal baby).
  • Polyhydramnios or excess amniotic fluid.
  • Hypocalcemia.
  • Hematologic alterations.

These complications in diabetic women who become pregnant could result in premature delivery, difficult delivery or force a cesarean section. For all these reasons, it is advisable to consult a specialist before attempting pregnancy.

Recommendations for pregnant women with diabetes

In general, diabetes should be considered to be controlled mainly through diet and regular physical exercise. Therefore, it is advisable to set regular comfort schedules and to control carbohydrate intake in particular.

If we are dealing with a case of type 2 diabetes treated with oral medication, it is advisable to stop the treatment and opt for insulin. Diabetic education will therefore be necessary in order to adapt to the process correctly.

If the diabetes is type 1, and insulin treatment is already being followed, it may be advisable to modify the usual dose and increase it gradually until delivery. In addition, there are reported cases of women with type 1 diabetes who also have low ovarian reserve, so it would be advisable to visit a fertility clinic if they wish to become pregnant.

Fertility treatments, like any other medical treatment, require that you trust the fertility specialists that will be by your side during your journey. Logically, each clinic has a different work methodology. Our Fertility Report will offer you a selection of recommended clinics, that is, fertility centers that have passed our rigorous selection process. Moreover, our system is capable of comparing the costs and conditions of each one so that you can make a well-informed decision.

Finally, it is also important to perform an ophthalmologic and renal function follow-up approximately every three months in diabetic women who become pregnant.

FAQs from users

What is the best treatment for gestational diabetes?

By Lidia Pérez García M.D., M.Sc. (gynecologist).

Gestational diabetes is a common endocrine pathology in pregnancy that develops due to an increase in placental hormones that can block the action of insulin resulting in a metabolic state of insulin resistance that will lead to an increase in blood glucose levels. Therefore, the treatment of gestational diabetes is focused on maintaining normal blood glucose levels, which is determined by blood glucose testing before and after meals.

Treatment must be individualized according to the characteristics of each patient. In most cases, blood glucose levels can be controlled with moderate physical exercise and a specific diet with a menu focused on avoiding sudden increases in blood glucose levels. Likewise, in overweight and obese patients, exercise and a healthy diet will improve the metabolic environment, reducing the risk of suffering this pathology.

Finally, in cases where blood glucose levels cannot be controlled with diet and exercise, the patient will be evaluated by an endocrinology team to begin treatment with injectable insulin, regulating the dose and type of insulin necessary to avoid episodes of hyperglycemia.

Can people with diabetes undergo assisted reproduction treatment?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Yes, many people with diabetes resort to assisted reproduction techniques because they have been trying for some time to become pregnant naturally without success.

Diabetes in itself is not a disadvantage for fertility treatment, although a thorough study of the patients will be necessary in case there are complications linked to the disease.

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Pregnancy is generally not recommended for women with diabetes who also have some of these associated pathologies:

  • Severe kidney disease.
  • High blood pressure that is difficult to control.
  • Ischaemic heart disease.
  • Severe proliferative retinopathy.
  • Severe autonomic neuropathy.

These diseases require the use of specific treatments that may adversely affect the foetus.

Could diabetes be transmitted in an egg donation pregnancy?

By Marta Barranquero Gómez B.Sc., M.Sc. (embryologist).

Diabetes is a metabolic disease that has a genetic component and is sometimes inheritable.

Therefore, it would be normal for diabetes not to be transmitted in an egg donation pregnancy, as egg donor candidates must undergo various medical tests before being accepted as egg donors. Under no circumstances can egg donor candidates suffer from genetic, hereditary or infectious transmissible diseases.

Suggested for you

As mentioned above, gestational diabetes is a type of this disease that usually subsides after delivery. If you would like to learn more about this condition during pregnancy, we recommend you visit the following link: What is gestational diabetes - Causes, symptoms and treatment.

On the other hand, diabetes is associated with an accumulation of ROS in the male reproductive tract. If you are interested in knowing more about this topic, you can read the following article: What is oxidative stress and how does it affect male fertility?

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Eleanor P Thong, Ethel Codner, Joop S E Laven, Helena Teede. Diabetes: a metabolic and reproductive disorder in women. Lancet Diabetes Endocrinol. 2020 Feb;8(2):134-149 (View)

Guo-Lian Ding, Ye Liu, Miao-E Liu, Jie-Xue Pan, Meng-Xi Guo, Jian-Zhong Sheng, He-Feng Huang. The effects of diabetes on male fertility and epigenetic regulation during spermatogenesis. Asian J Androl. 2015 Nov-Dec;17(6):948-53. doi: 10.4103/1008-682X.150844 (View)

Paolo Facondo, Elena Di Lodovico, Andrea Delbarba, Valentina Anelli, Letizia Chiara Pezzaioli, Erica Filippini, Carlo Cappelli, Giovanni Corona, Alberto Ferlin. The impact of diabetes mellitus type 1 on male fertility: Systematic review and meta-analysis. Andrology. 2022 Mar;10(3):426-440. doi: 10.1111/andr.13140. Epub 2021 Dec 22 (View)

FAQs from users: 'What is the best treatment for gestational diabetes?', 'Can people with diabetes undergo assisted reproduction treatment?', 'When is pregnancy not recommended for women with diabetes?' and 'Could diabetes be transmitted in an egg donation pregnancy?'.

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Authors and contributors

 Lidia Pérez García
Lidia Pérez García
M.D., M.Sc.
Dr. Lidia Pérez has a degree in Medicine and a Master's Degree in Human Reproduction from the Complutense University of Madrid. More information about Lidia Pérez García
License: 282870961
 Luis Rodríguez Tabernero
Luis Rodríguez Tabernero
M.D., M.Sc., Ph.D.
Degree in Medicine and Surgery from the University of Salamanca and Specialist in Obstetrics and Gynaecology via MIR. Dr. Rodríguez Tabernero is responsible for the Human Assisted Reproduction Unit of the Gyaecology and Obstetrics Department of the Hospital Clínico Universitario de Valladolid since 2013 and has also been working in the field of reproductive medicine since 2000. More information about Luis Rodríguez Tabernero
Licence number:474705276
 Marta Barranquero Gómez
Marta Barranquero Gómez
B.Sc., M.Sc.
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
Adapted into english by:

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