As November is National Diabetes Month, we (Reproductive Medicine Associates of Connecticut – RMACT) are continuing on our theme about how our fertility is affected by insulin resistance.
Here’s more information – with today’s focus on PCOS and insulin resistance. It’s such an important connection and one that is often overlooked. If you’re trying to get pregnant, it can be the connection that makes all the difference.
Carolyn Gundell, MS, RMACT Nutritionist, explains the risk factors and how they correlate to your fertility. No one is better qualified than Ms. Gundell to explain it. What a relief that she is also able to explain it in such an understandable way. ~Lisa Rosenthal
A Few Facts Revealed about Diabetes Risk in PCOS
Polycystic ovarian syndrome (PCOS) is the most common endocrine condition causing infertility in women. PCOS is characterized by elevated androgens, ovulatory and cardio-metabolic dysfunction, insulin resistance, and weight gain.
Why should women and partners be concerned with risk for diabetes during the preconception period?
Researchers have found that women and men with elevated blood sugar and insulin resistance are at greater risk for fertility challenges. Changes in reproductive function and hormones can occur with higher hemoglobin A1c (blood sugar) levels and may cause longer time to pregnancy or higher chance of miscarriage. In early pregnancy, uncontrolled or undetected diabetes raises the risk for birth defects.
Is polycystic ovarian syndrome (PCOS) associated with diabetes risk?
Yes. Individuals with polycystic ovarian syndrome are often challenged with insulin resistance. Insulin is a hormone that helps move blood sugar from the bloodstream into cells to use as energy. When cells do not respond to the rising blood sugar, the level of insulin increases as the pancreas produces more and more insulin-a condition known as insulin resistance. Insulin resistance means that the body becomes desensitized to insulin and loses the ability to regulate blood sugar and raises risk for diabetes.
Insulin resistance occurs in thirty percent of lean women with PCOS and ninety-five percent of overweight women with PCOS.
Too much insulin increases androgen production by the ovaries. Androgen excess and insulin resistance are responsible for sixty to eighty-five percent of irregular or absent ovulation in women with PCOS.(1)
More than fifty percent of women with PCOS will have either type 2 diabetes or pre-diabetes before age forty. (1)
Gestational diabetes mellitus (GDM) is the most common pregnancy complication in women with PCOS at three times the risk of a pregnant woman without diabetes. (2)
What can a woman do to decrease PCOS related symptoms, increase her fertility and help to assure a healthier pregnancy?
Optimizing Health During Preconception
- Regular aerobic and weight resistant physical activity at a vigorous level prior to fertility cycling is associated with improved glucose control, insulin sensitivity, and cholesterol levels.(3) Performing consistent exercise also helps to support weight loss, lower androgens, improve insulin action, and regulate ovulation. Once fertility treatment starts, continue daily low-moderate movement, such as walking to support pregnancy success.
- Weight loss, if recommended, lowers glucose, improves insulin resistance and in turn can regulate ovulation. Abdominal weight loss prior to pregnancy has a positive effect at reducing risk for GDM.
- Following a healthy and balanced meal plan with fertile friendly concepts will support weight loss and fertility while reducing cardio-metabolic risk. Visits with an RMACT nutritionist are covered under medical insurance.
- Discuss with your fertility physician whether an insulin sensitizer, metformin, would be appropriate for your PCOS management.
- Getting greater than six hours of quality, restful sleep will support weight loss and lower diabetes risk.
- Practicing stress management behaviors such as Fertile Yoga, meditation, acupuncture and breathing supports a healthy lifestyle balance.
Optimizing Health During Pregnancy
- To reduce risk for GDM once pregnant, women with PCOS should:
- Be active with at least thirty minutes of daily movement with appropriate medical supervision (obstetrician or midwife) to control weight gain and sensitize insulin. Walking and prenatal yoga is appropriate in the first trimester.
- Consult with a nutritionist for meal plan support.
- Consult with your obstetrician about testing for GDM.
- Continue stress management behaviors.
1) Speroff et al. Clinical Gynecologic Endocrinology and Infertility. 8th Edition, 2010
2) Palomba, S et al. International Journal of Women’s Health. Complications and challenges associated with polycystic ovary syndrome: current perspectives, 2015:7 745-763.
3) Greenwood EA et al. Fertility Sterility. Vigorous exercise is associated with superior metabolic profiles in polycystic ovary syndrome independent of total exercise expenditure, 2015 Nov 6.