INSULIN AND INFERTILITY

Q: My doctor told me I’m pre-diabetic. We were thinking of starting a family soon. How will this affect my fertility? I might have PCOS as well. What is the link between the two?

A: Dr Carmen James answers: Prediabetes is a condition that occurs when your blood glucose levels are higher than normal but not high enough to be diagnosed with actual diabetes. Prediabetes usually occurs in people who already have some insulin resistance. Polycystic ovarian syndrome (PCOS) is a common reproductive disorder that affects around 15 percent of women. And 60-80 percent of women with PCOS also suffer from insulin resistance. The relationship between insulin resistance and PCOS is mutually destructive in that PCOS worsens insulin resistance and vice versa. High insulin levels are a feature of PCOS, but they also fuel the disease. The reason for this is because insulin accumulation reduces ovulation and promotes the production of androgens or male hormones. This results in symptoms such as a male pattern of hair growth (hirsutism), acne and in some cases is associated with difficulties with fertility. More than 50 percent of women with PCOS will develop diabetes or pre-diabetes before the age of 40. With so many women affected by PCOS or insulin resistance, the effect on fertility can be heartbreaking. But exactly how does having insulin resistance affect fertility? Ovulation occurs during a normal menstrual cycle where an egg is released from the ovary and passes through the fallopian tubes and into the uterus. If the egg isn’t fertilised, the egg, together with the uterine lining, will be shed during menstruation. Because an accumulation of insulin in the bloodstream elevates androgen levels, the resulting hormone imbalance will negatively affect ovulation. When women don’t ovulate, they may menstruate less frequently, have irregular cycles and in some instances, they may not menstruate at all. If an egg isn’t released into the uterus, conception won’t occur. PCOS is the most common cause of irregular menstruation that leads to infertility. While it’s more likely for overweight and obese women to experience insulin resistance and PCOS, women of a normal weight can be affected too. Weight alone isn’t an absolute representation of health. I strongly recommend if you have PCOS and/or insulin resistance, you address the underlying root cause of the condition. While we can’t control our genes, we can aim to live a healthy lifestyle to reduce the negative effects of both PCOS and insulin resistance. Follow a healthy diet rich in plantbased foods and low in refined carbohydrates; enjoy regular physical exercise; add supplements including myoinositol, curcumin, antioxidants, folate and berberine; manage stress levels; and get enough sleep. These measures will reduce inflammation, improve insulin sensitivity and bring balance to the hormones to support ovulation.