Infertility Due to Diabetes, Thyroid & Other Endocrine Disorders

Diabetes, endocrine disorders & infertility facts

• Endocrine disorders are conditions that affect the body’s endocrine system, which includes glands that produce hormones to regulate various bodily functions like metabolism and reproduction.
• Diabetes is the most common endocrine disorder diagnosed in the United States.
• Issues with endocrine function can lead to health concerns such as diabetes, polycystic ovary syndrome (PCOS) and thyroid conditions like hyperthyroidism and hypothyroidism.
• These in turn can significantly impact the ability to conceive, as well as affect pregnancy and a resulting child.
• Dallas IVF physicians – all certified in reproductive endocrinology & infertility – are experts at solving the fertility problems caused by these endocrine disorders.

Understanding diabetes and other endocrine disorders

Endocrine glands regulate important body functions such as metabolism, mood, growth and fertility in women and men. Endocrine disorders occur when the endocrine glands do not produce the right levels of specific hormones.

Diabetes can result either from the endocrine disorders or from improper functioning of the endocrine glands.

Endocrine glands are located in various parts of the body. Primary glands and their functions are:

• Hypothalamus – impacts pituitary function.
• Pituitary is the master gland that influences other glands and functions like growth.
• Thyroid controls growth and metabolism.
• Adrenal glands make the hormones adrenaline and corticosteroids.
• Pancreas are responsible for insulin, which regulates blood sugar.
• Gonads (ovaries/testes) are responsible for producing gametes (eggs/sperm).

How diabetes and other endocrine disorders affect fertility

Endocrine disorders, including diabetes, can cause or contribute to both female infertility and male infertility by interrupting the reproductive glands and tissues that can disrupt hormonal balance critical for functions like ovulation, menstruation and sperm production.

Reproductive endocrinologists

Fertility medicine is centered around understanding of the endocrine system. All fertility specialists are certified in reproductive endocrinology or the more advanced certification of reproductive endocrinology and infertility (REI).

All Dallas IVF doctors are REIs. As such, they are specifically trained to address endocrine disorders affecting fertility.

Endocrine disorders affecting fertility

• Diabetes: Impairs the body’s regulation of blood sugar.
• Hypothyroidism: Underactive thyroid, causing low thyroid hormone levels.
• Hyperthyroidism: Overactive thyroid, making excess thyroid hormones.
• Other thyroid disorders: These include Hashimoto’s disease, an autoimmune disorder.
• Ovulation problems: Issues with the release of eggs from ovaries.
• Primary ovarian insufficiency: The ovaries cease to function before normal.
• PCOS: A hormonal imbalance causing irregular periods and cysts on the ovaries.

Further details on these conditions and how they cause infertility are below.

Understanding type 1 diabetes & type 2 diabetes

Diabetes is a disease in which the body can’t properly manage blood sugar (glucose). Type 1 diabetes involves the pancreas producing little to no insulin. Type 2 is when the body doesn’t respond well to insulin, which regulates glucose in the blood.

Diabetes cause and symptoms

Type 1 is caused by genetics and by autoimmune disease that destroys cells in the pancreas that produce insulin. Type 2 diabetes occurs due to insulin resistance in the body’s cells and by the pancreas not being able to produce enough insulin. Diabetes can also be caused by some medical conditions.

Diabetes symptoms include excessive thirst, hunger, urination, fatigue and weight loss or weight gain.

The disease can impair fertility in women and in men by causing hormone imbalances, ovulation difficulties and decreased sperm quality. The longer a person has had diabetes, as well as the severity of the disease, has a bearing on the extent of diabetes’ effect on fertility. Not everyone with diabetes experiences infertility related to it.

Diabetes and female infertility

The condition’s effects on hormone regulation can hamper female fertility in several ways.

• Irregular or absent periods. Uncontrolled blood sugar disrupts the delicate hormone balance required for regular ovulation.
• Anovulation. This is when the ovaries fail to release an egg each month, making conception impossible.
• PCOS. Women with type 2 diabetes have a higher risk of PCOS, which further disrupts ovulation.
• Miscarriage: Uncontrolled blood sugar in early pregnancy increases the chances of miscarriage and recurrent miscarriage.

Diabetes and male infertility

The disease can cause damage to sperm health and cause conditions that impede normal delivery of sperm during intercourse.

• Sperm quality. Diabetes can result in a decrease in sperm count, harm sperm motility (movement) and increase the amount of abnormal sperm production.
• DNA damage. High blood sugar can harm the DNA in sperm, increasing the risk of miscarriage, as well as birth defects in a child.
• Hormone imbalance. Diabetes can disrupt the production of testosterone and other hormones affecting sperm health and a man’s sexual function.
• Erectile dysfunction. Excessive blood sugar can damage nerves and blood vessels, making it difficult or impossible to achieve or maintain an erection.
• Retrograde ejaculation. Damage to nerves related to ejaculation can cause semen to flow backward into the bladder instead of forward from the penis.

How infertility treatments are affected by diabetes

Men and women with diabetes can have success with infertility treatments, whether or not the infertility is caused by diabetes. Before beginning treatment, we advise that diabetics receive preconception counseling, optimize their blood sugar levels, manage their diet and exercise if necessary to attain a healthy weight, and adjust their medications under the guidance of their doctor.

How diabetes can affect pregnancy and the baby

Diabetic women should have their blood sugar levels at optimum levels before becoming pregnant. They should maintain those target range levels during pregnancy, which can be different than before pregnancy. Women with diabetes can get these personal recommendations from their doctor during pre-pregnancy counseling or as soon as they know they are pregnant.

The National Institute of Diabetes and Digestive and Kidney Diseases reports that poor blood sugar can harm the baby before the woman even knows she is pregnant. Diabetes can cause these problems for the mother during pregnancy:

• Increased risk of developing high blood pressure that can complicate the pregnancy.
• Preeclampsia, a serious complication that can cause high blood pressure, protein in the urine and swelling.
• Increase risk of a miscarriage or a stillborn child.
• Heighten the chance of infections due to high blood sugar levels that weaken the immune system. Vaginal yeast and urinary tract infections are common results.
• Increase the chance of needing a C-section delivery.

The effects of poor blood sugar levels begin at 8 weeks of pregnancy and can affect the development of the baby’s organs and its birth. Diabetes can cause these problems for the baby:

• Severe birth defects such as spina bifida, heart defects, and abnormal formations of limbs, kidneys and the urinary tract.
• Having a large baby of over 9-10 pounds, known as macrosomia, can lead to difficult delivery and injuries to the child.
• Preterm birth, which can cause several problems such as difficulty breathing, developmental issues, trouble feeding, and hearing and vision difficulties.
• Low blood sugar levels at birth.
• Increased risk of obesity and type 2 diabetes later in life.

Hyperthyroidism and fertility

Hyperthyroidism is the over production of thyroid hormones that speeds up the body’s metabolism and affects about 1% of people 12 or older in the U.S. It’s often caused by medical conditions such as overactive thyroid nodules, thyroiditis (inflamed thyroid glands) and the autoimmune condition Graves’ disease.

Symptoms can vary widely and include abnormal heart rate, nervousness and anxiety, tiredness and losing weight.

Hyperthyroidism can also over produce the reproductive hormones estrogen, progesterone and testosterone, which affect fertility in men and women.

Hyperthyroidism effect on female and male fertility

• Women may experience irregular menstrual cycles and even no periods (amenorrhea), which can disrupt ovulation and affect conception. Miscarriage risk also increases. The condition can decrease a woman’s sex drive, affecting her chances of conception.
• Men can have poor sperm quality and count due to hyperthyroidism’s effect on sperm production. Erectile dysfunction and lowered libido (sex drive) can also affect the male’s ability to get his partner pregnant.

Many people with the condition experiencing difficulty conceiving can have success after hyperthyroidism is effectively treated.

Does hyperthyroidism affect fertility treatments or pregnancy?

Because of the effects of the condition noted above, fertility treatments may not be successful until the hyperthyroidism issues are resolved. However, Dallas IVF specialists may recommend treatments depending on the level of the conception difficulties assessed due to hyperthyroidism.

Pregnant women with the condition require careful management during pregnancy, according to the National Library of Medicine. Hyperthyroidism can cause heart failure, miscarriage, preeclampsia, preterm birth and a child with low birth weight.

Hypothyroidism and fertility

Hypothyroidism is when the thyroid gland does not produce enough thyroid hormones, including those necessary for reproduction. Female fertility is affected because the reduced production can result in problems with the ovaries, uterus and in placental tissue with pregnancy.

Hypothyroidism can be caused by other conditions, with the autoimmune disorder Hashimoto’s disease being the most common cause of hypothyroidism. Thyroiditis, thyroid surgery, medications and radiation therapy can also cause the condition. Symptoms include weight gain, feeling tired, constipation, sensitivity to cold and others.

Hypothyroidism’s effect on male and female fertility

• Male fertility can be affected by hypothyroidism. This is due to problems with sperm production and erectile dysfunction.
• Women with the condition can experience difficulty conceiving due to improper release of eggs caused by lower levels of necessary hormones. Some causes of the condition can themselves affect female fertility, such as pituitary issues and autoimmune disorders.

Those with hypothyroidism seeking to become pregnant should first get the condition under control if possible. It may be necessary to see a fertility specialist. If the condition can’t be corrected, fertility treatments can be successful for those with hypothyroidism.

Moreover, women with the condition who become pregnant should speak to their doctor as soon as possible. Hypothyroidism can increase the risk of fetal development problems and miscarriage.

Primary ovarian insufficiency, amenorrhea & irregular periods

These conditions that affect female infertility can be caused by endocrine disorders, including the conditions mentioned above.

• Primary ovarian insufficiency is when the ovaries malfunction before age 40. Previously referred to as premature ovarian failure, primary ovarian insufficiency involves a drop in the ovaries’ production of estrogen and problems with regular ovulation. Women with this condition can have irregular periods for years. While they can become pregnant, it is often difficult. Treatments can help.
• Amenorrhea is when a woman does not have a period, which means the woman has infertility. Amenorrhea is not a disease itself but is caused by other conditions, one of which is problems with reproductive endocrine hormones. Once the condition causing amenorrhea is corrected, fertility can return.
• Irregular periods do not last the typical 4-7 days and do not occur about every 28 days. They may occur less than 21 days or more than 34 days apart. This irregularity can affect fertility primarily through disruptions to ovulation. Irregular periods can result from endocrine disorders such as PCOS (see below), thyroid dysfunction, hypothalamic dysfunction, elevated prolactin, and other conditions and risk factors.

Addressing known underlying causes of irregular periods, if possible, can increase the chances of pregnancy. For many of those who have irregular periods, fertility treatment via medications to promote ovulation is the primary treatment.

Polycystic ovary syndrome (PCOS) and infertility in women

PCOS is one of the most common endocrine disorders that can lead to infertility in women. The exact cause of PCOS is unknown, but experts suspect it is genetically related to problems of insulin regulation, which relates to diabetes. Symptoms include irregular periods, no periods, male hair growth patterns, infertility and others. There is no one test to diagnose PCOS, a fertility specialist will perform a series of exams and evaluations to rule out other causes for symptoms before diagnosing PCOS.

Polycystic ovary syndrome may be associated with elevated male hormone levels in women. This causes ovarian disruption or improper development of eggs, both of which can result in infertility.

Having PCOS can affect infertility treatment success related to issues of ovulation. Medications to promote ovulation can be different for women with PCOS. Some women with PCOS may need donor eggs to conceive.

PCOS effects on pregnancy

Pregnant women with PCOS need close management by their OB-GYN. Several issues in pregnancy can be caused by a mother with PCOS. It increases the risk of gestational diabetes, high blood pressure and preterm birth. The resulting child of a PCOS pregnancy can have a low birth weight.

More on PCOS