Dietitian Larissa Telfer works in both private practice in Geelong and in hospital as a clinical dietitian. She’s also a qualified diabetes educator (CDE) and enjoys working with people with Type 1 diabetes throughout pregnancy, using latest the technology. Today, I speak to Larissa about how diabetes can affect fertility. Does it matter if you have Type 1 or Type 2? We’ll answer these questions and more.

Q. Does diabetes affect fertility? Does it matter which Type you have?

Yes, both Type 1 and Type 2 diabetes impact fertility in different ways.

Type 1 diabetes

Fertility issues can occur due to general dysfunction in the hormonal control responsible for stimulating a regular menstrual cycle. The longer the duration of Type 1 diabetes in women, the more they are at risk of these irregularities. Women with Type 1 diabetes are also at a greater risk of other autoimmune conditions such as Coeliac disease and Hashimoto’s thyroiditis which can contribute to infertility if not identified and treated.

Type 2 diabetes

The prevalence of Type 2 diabetes in women of child-bearing age is increasing. The common contributing factors to Type 2 diabetes include obesity and PCOS, both of which can cause fertility issues on their own. Driven by insulin resistance, Type 2 diabetes impacts fertility due hormonal imbalances and lack of regular menstrual cycles.

Q. How does it affect a women’s chances of falling pregnant?

In women with Type 1 diabetes, infertility appears to be decreasing due to advances in medical management. Much of the evidence in this area is population-based research and shows that people with Type 1 diabetes have fewer children than those without. However, the exact reason for this is difficult to determine. The likelihood of fertility issues in women with Type 1 seems to increase in the presence of other diabetic complications.

Q. What are some considerations for someone planning on pregnancy?

It’s important to know that women with diabetes can still fall pregnant and have a healthy pregnancy. Glycaemic control at conception is important for the prevention of congenital abnormalities, the risk of which is increased if blood glucose levels are elevated. Guidelines for pre-existing diabetes and pregnancy recommend that women delay pregnancy if their HbA1c is above 10%, as this is associated with a significantly increased risk of congenital abnormalities and miscarriages. Ideally, we aim for HbA1c to be less than 6.5%.

Q. Does diabetes affect men’s fertility?

Yes, both Type 1 and Type 2 diabetes can affect male fertility. High blood glucose levels can impact male fertility in a few different ways:

• Erectile dysfunction
• Sperm quality
• Sperm motility
• The DNA integrity of sperm and the ingredients in the fluid released around the sperm (seminal plasma)

Men with Type 1 diabetes have reduced sperm volume and reduced sperm motility whereas in Type 2 diabetes inflammation drives changes in sperm DNA and vitality.

Q. What can be done to help manage diabetes? How can a fertility dietitian help?

The first step for women with all types of diabetes is to achieve the best possible control of blood glucose levels, in order to optimise chances of falling pregnant and ensure best outcomes.

Dietitians with experience in fertility and diabetes can provide support, develop your skills and further your understanding in how food impacts our blood glucose levels. This might be refreshing skills around carbohydrate counting or reviewing carbohydrate needs based on your requirements, for example. They can work with you to provide a plan tailored to your individual nutrition needs, fertility goals and preferences.

Dietitians are also able to support women with general nutrition advice relating to fertility to achieve a healthy weight for conception. For example, we know above or below a healthy weight range has a significant impact on chances of falling pregnant.