Blood Sugar Regulation & Fertility - How are the two related?
Insulin Resistance & Fertility - not just a concern for those with PCOS
In that first appointment together, we are taking the time to dive deep into your reproductive history, your health, and all investigations into your fertility so far. We go into your diet, lifestyle habits, sleep, and stress and oftentimes patients wonder “What does all this have to do with me trying to conceive?”
I want to take a moment to dive deeper into one area that we often don’t consider when supporting our fertility, and that’s blood sugar regulation. Typically, the standard is to measure your fasting glucose, to see if your blood sugar is elevated even after not eating for 10-12 hours, and your hbA1c which helps identify pre-diabetes & diabetes.
As a Naturopathic Doctor, I like to dig a little deeper. Even though the tests above are important it doesn’t capture the nuances in how well your body is managing blood sugar. What I am searching for is something called insulin resistance.
What is insulin resistance?
Whenever we eat, our food gets metabolized into blood sugar (glucose). In response, our pancreas releases a hormone called insulin to facilitate bringing that glucose into our cells for fuel. With insulin resistance, our cells are having a difficult time responding to insulin to let glucose into the cell. As a result, we get an increase of insulin and glucose in our bloodstream that should be in our cells. Our body can tolerate this increase of insulin and glucose for years before it ever flags elevated fasting blood glucose and/or elevated hbA1c.
Insulin resistance is often present in those with Polycystic Ovarian Syndrome (PCOS) and it is one of the main reasons for worsening PCOS symptoms. However, we can see insulin resistance in populations outside of this condition. I see it quite often and can be a contributing factor that is affecting a person’s fertility potential (see more details below).
There are many factors that can cause or worsen insulin resistance such as:
Genetic predispositions & family history of Diabetes
Hormonal conditions such as Cushing’s, PCOS, Hypothyroidism, Acromegaly
Inherited genetic conditions
Poor Sleep Quality/Lack of Sleep
A diet high in Carbohydrates & Saturated Fats, & dietary habits
Stress - high cortisol dumps more glucose into our bloodstream
Low Muscle Mass
High levels of inflammation, which can be due to many different causes
Certain Medications (obviously, do not stop your medications without consulting your doctor!)
How do we test for it? Unfortunately, there is not one perfect test for confirming and monitoring the progression of insulin resistance, but here is what we can do. Review your:
Check for Signs & Symptoms (I’ll do another post on this later)
Confirm with Lab Work:
A simple Fasting Glucose & Fasting Insulin (blood test) to determine your HOMA-IR score
2 Hour Oral Glucose Tolerance test can be helpful as well but requires 2 hours of your day
I do also recommend that if we are monitoring insulin resistance that you are up to date with your hbA1c and lipid panel
So how does insulin resistance impact fertility?
Higher levels of insulin circulating throughout the body can trigger inflammation. These inflammatory markers can be damaging to egg & sperm quality
Insulin resistance can negatively impact sperm parameters and lower testosterone in males
Higher levels of insulin can inhibit or delay ovulation
Higher insulin levels shift hormone production from estrogen to testosterone in females, causing delayed maturation of the follicles
High insulin can affect the endometrial functions and environment, and therefore impact embryo implantation
High Insulin can contribute to high secretions of luteinizing hormone which can hinder ovulation
Insulin resistance present in those with PCOS increases the risk of miscarriage & macrosomia (large birth weight), even when doing an embryo transfer
We also want to be proactive about managing insulin resistance to reduce the risk of gestational diabetes
It is alarming all the ways in which insulin resistance can impact fertility, and yet it isn’t a typical conversation we are having when trying to conceive. Thankfully, insulin resistance is something that we can address quite easily and with continued management keep in remission.
Depending on your unique situation this may look like a combination of dietary, lifestyle, supplement, and possible medication support to keep blood sugar stable and insulin levels down, allowing your body a chance to lower inflammation & optimize hormonal signaling.
If you are an Ontario resident and you are interested in exploring the possibility of insulin resistance in yourself and how to address it, book a free 15-minute discovery call and I’d be happy to discuss it in more detail with you!