Doctors reveal whether diabetes and obesity, the rising epidemics affecting millions worldwide and known to cause hormonal disruptions, affect fertility and reproductive health in both men and women
Infertility is a condition of the reproductive system that is characterised by the inability to bear a child through biological process and the emotional cost associated with infertility is best understood by individuals and couples who have faced the condition. Fertility rates have been continuously declining in the country and the growth of several non-communicable and progressive diseases like obesity and diabetes have been found to be one of the root causes for this.
While out-of-balance hormone levels don’t always mean a woman will have trouble getting pregnant but health experts say she may experience less regular ovulation and menstrual cycles which makes it harder to conceive. Systematic studies of the metabolic effects of obesity and both type 1 and type 2 diabetes mellitus (T1DM, T2DM) on the hypothalamus-pituitary–ovary (HPO) axis have revealed a relationship between them and menstrual disturbances, such as delayed menarche and premature menopause, alterations in the menstrual rhythm (including primary and secondary amenorrhoea, oligomenorrhoea) and potential consequences on fertility and fecundity (like miscarriages, preterm delivery, foetal anomalies, macrosomia, etc.).
Diabetes and obesity are rising epidemics affecting millions worldwide and are known to cause hormonal disruptions, thus affecting fertility and reproductive health in both men and women. In an interview with HT Lifestyle, Dr Sujit Ash, Consultant, Gynaecology and Obstetrics, PD Hinduja Hospital & Medical Research Centre at Khar, shared, “Predominantly, there is a change in the pulsatile secretion of the Gonadotropin-releasing hormone (GnRH) which affect Luteinizing hormone (LH) and Prolactin leading to anovulatory cycles. With current-day dietary and lifestyle patterns, T2DM along with obesity (imbalance between estrone and estradiol ratio) and polycystic ovarian syndrome (PCOS) affects reproductive health. There is an increased level of circulating leptin with reduced sex hormone binding globulin (SHBG) and a low level of circulating adiponectin leading to poor sensitivity to insulin and fat breakdown, and difficulty in conception. This can further be complicated with decreased libido and frequent genitourinary infections.”
According to National Center for Biotechnology Information (NCBI), menstrual dysfunction and anovulation (lack of ovulation) are more likely in overweight and obese women where they are more prone to infertility and sub fecundity. These women have higher rates of conception, miscarriage and pregnancy problems. Dr Kshitiz Murdia, CEO and Co-Founder of Indira IVF, said, “Type 1 diabetes patients also experience delayed menarche and early menopause, as well as delayed ovulation and irregular menstrual cycles, compared to their non-diabetic counterparts. PCOS is a condition that affects 5-13 percent of females of reproductive age and is associated with insulin resistance and elevated testosterone levels. It causes female infertility in the majority of cases. Irregular menstruation is linked to both type 1 and type 2 diabetes, making it harder for females to conceive.”
For men, diabetes and obesity are known to lead to sexual dysfunction like erectile disorders and decreased libido, along with epigenetic dysregulation during spermatogenesis leading to poor sperm quality, motility and DNA damage (due to genetic mutations and deletions). Dr Kshitiz Murdia revealed, “In men, obesity can result in sexual dysfunction, endocrinopathy (endocrine gland illness), and other conditions, in addition to poor semen quality. Diabetes affects male fertility by altering hormone levels, lowering sperm quality, and making it difficult to get an erection and ejaculation. Males with Type 1 diabetes have fewer motile sperm than their counterparts, which is found to deteriorate over time. When testosterone levels in males are lower than normal, it is linked to increased fat deposition and obesity. By developing insulin resistance, this can lead to Type 2 diabetes. Reduced testosterone levels also contribute to a drop in sperm count and libido.”
It is advisable to see a doctor if a couple facing obesity or diabetes is planning to get pregnant in order to spot and take care of any problems that might hinder fertility. The doctors may advise a detailed nutrition plan, some exercise and even medicine as per necessity. For the body to rectify hormone imbalances and reduce the risk of diabetes, PCOS and obesity, these kinds of treatments are crucial. Expectant parents must first prioritise their personal health in order to provide for the wellbeing of their unborn children.
For both men and women, treating infertility with diabetes and obesity involves the study of the medical history and family history of the couple together, adopting a healthier lifestyle with weight loss, adequate diet, and regular exercise, with enhanced glycaemic control (oral medications like metformin and/or insulin), along with managing reproductive hormones and sexual dysfunctions by involving a multidisciplinary approach including a gynecologist, an endocrinologist, a nutritionist, a lifestyle coach, etc.
