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DIABETES AND
OBESITY

FERTILITY ISSUES

IN WOMEN WITH DIABETES

By Jaye Adams, MD

T he prevalence of diabetes, both

type 1 and type 2, is increasing in
women of reproductive age and,
as with other chronic diseases, may affect a
woman’s ability to conceive (1, 2). Com-
monly understood is the increased risk of
adverse maternal and fetal outcomes with
pre-existing diabetes (3, 4), and the need for
pre-conception glycemic control (5, 6). Per-
haps less well understood is the effect of di-
abetes itself on the overall fertility of
women with this health condition. Given
the considerable variability in phenotype
and disease pathophysiology in women with
type 1 and type 2 diabetes, a general sum-
mary of fertility implications for women
with diabetes is prone to oversimplification
and may pose more questions than it answers. However, surely Intimately linked with the diagnosis of both type 1 and 2 diabetes
there are some unifying themes that can aid us in the counseling and menstrual abnormalities is the often coexisting diagnosis of
of women with diabetes who present with concerns about their PCOS (polycystic ovarian syndrome), the most common endocrine
ability to conceive. abnormality of reproductive-aged women (11, 12). While women
with diabetes may have normal ovulatory cycles, or menstrual anom-
Does diabetes cause menstrual abnormalities? alies not associated with PCOS, the diagnosis of PCOS is increased

Menstrual irregularities and ovulatory dysfunction are increased in women with both type 1 (13) and type 2 (14) diabetes mellitus.
in women with both type 1 and 2 diabetes (7, 8). A delay in menar- Using the Rotterdam criterion (15) for the diagnosis of PCOS, with
che and more severe oligomenorrhea in adolescents with type I di- two of the following three findings: 1) evidence of clinical or bio-
abetes has been shown to correlate with the degree of elevation of chemical hyperandrogenism, 2) oligo-anovulation, and/or 3) poly-
HbA1c and insulin requirements (9). Even with good glycemic con- cystic appearing ovaries on ultrasound, excluding other
trol, oligomenorrhea remains common in young women with type endocrinopathies; approximately 40 percent of women with type 1
I diabetes, but may improve with advancing age (7). Women with diabetes (13) and 26-37 percent of women with type 2 diabetes (8,
type 2 diabetes also have an increased risk of oligomenorrhea which 14) meet the criteria for PCOS. because 50-70 percent of women
is more prevalent as their degree of obesity and metabolic dysreg- with PCOS may have insulin resistance when carefully assessed (14,
ulation worsens (8, 10). Efforts to optimize bMI (body mass index), 16), these women should also be screened for coexistent diabetes
glycemic control, and hyperinsulinemia may improve spontaneous and educated about their significantly increased lifetime risk of de-
ovulation and conception rates. veloping type 2 diabetes (12). diabetic women with PCOS typically

18 San Antonio Medicine • December 2018