Growing up with type 1 diabetes, I heard a lot from my healthcare team about the risks of getting pregnant. I was told that if I did not have an A1C less than 6%, there were many risks to the fetus and that I was more likely to have a miscarriage. When I talk to my diabetes peers who can get pregnant, they say they heard similar messaging. What was and remains unclear, however, was whether living with diabetes decreased your ability to conceive. While this topic hasn’t been widely addressed, many women I know have shared a common feeling—that we previously believed conception might be difficult for us.
Recent research findings
There is not a significant amount of research in this area, and when reviewing studies, I was surprised to find that fertility was defined differently in some studies. In one large Finnish study from 2012, fertility was defined as the number of children, not the ability to reproduce.1 Other studies focused on the effects of diabetes on the genital organs or gametes. The two Finnish studies from the early 2010’s concluded that both women and men with type 1 diabetes produced less children than their matched cohorts.1,2 It’s important to note that this may not be indicative of the ability to reproduce, but the number of children born.
There are some possible complications related to diabetes that may contribute to fertility, such as erectile dysfunction and irregular menses. Women with T1D are also more likely to have polycystic ovarian syndrome (PCOS), which negatively impacts fertility without treatment. There have also been studies showing that hypothyroidism, another common condition that co-exists with T1D, can affect fertility in women by altering normal menstrual cycles.3
Ovary-related research
For people with a uterus, there has been a significant delay in the amount of research about our bodies, which has been steadily improving in recent times. For females with T1D, a lot of the focus related to fertility has been focused on the ovaries. Earlier findings about T1D’s effects on the ovaries have shown that menopause usually starts at a younger age therefore decreasing the amount of time a woman is fertile.4 More recently, a meta-analysis from 2022 demonstrated that women with T1D may have a decreased level of a hormone called Anti-Müllerian hormone (AMH) which can indicate status of ovarian health.5
Finding the cause of why the ovaries are negatively impacted has been the focus of several other studies. In 2016, a group of researchers in London studied 150 women with T1D to see if the early menopausal symptoms were caused by impaired vascular health. They determined this is not the cause of early aging of the ovaries for women with T1D.4 Another study published in 2020 observed that the level of AMH is negatively impacted by high HbA1C levels.6 More research is needed to determine the specific cause of impairment in ovary function.
Sperm-related research
There is a decent amount of research on sperm and both type 1 and type 2 diabetes. A study of sperm from 38 people with T1D and 55 people with T2D concluded that T1D was associated with lower volume of semen.7 This study suggests that the lower volume may be related to an impaired ability of the epididymis to contract normally. Another large meta-analysis from 2022 reviewed many studies and came to the following conclusions:8
- Sperm count is likely not affected by T1D diagnosis
- Sperm motility may be impacted by T1D
- Number of children from men with T1D was lower than controls – especially when men lived with T1D for a long duration
- Data on other potential issues with sperm (i.e. morphology) was inconclusive
- Larger studies should be conducted to obtain stronger level of evidence
The most recent study from June 2024 looked at 42 male patients with T1D and 43 non-T1D matched for comparison.9 This study showed that the male participants also had impaired mobility of sperm but did find that the sperm count was lower in patients with T1D. Additionally, the study concluded that there were higher rates of erectile dysfunction, a known possible complication of T1D. This study specifically looked at HbA1C levels in comparison to semen volume and found that the higher the HbA1C, the more likely to have lower semen volume. The study authors also suggest further research to ensure their data can be extrapolated to the larger population.
Avoiding reproduction by choice
This study was cited in one of the reference articles and it’s another point that should be discussed. The results state that, “women reported that their diabetes had a negative influence on their attitude toward having children.”10 The study is from 1992, which is long before wide usage of insulin pumps and even longer before use of CGM’s. However, I know this is something I personally grappled with prior to becoming a mother. I have also met many people who express the desire to adopt as to not risk passing diabetes onto their children.
After deliberating and considering, I did decide to proceed with a pregnancy with T1D, and am grateful that I did. But I did not do it a second time. I had always wanted to adopt, and after the challenges experienced in my pregnancy, I felt like it was a sign that adoption was the path for me. I am equally grateful that our daughter joined our family and wouldn’t have it any other way.
I can also say that the ability to conceive was not an issue for me, thankfully, and even a little bit terrifying. I can say with absolute certainty it only took one try for my son to take root in my uterus. And I was sure to get an intrauterine device (IUD) to make sure it wasn’t an issue in the opposite way. Can T1D affect your fertility? Maybe, but also maybe not. So, make sure you’re taking the proper precautions if you don’t want a tiny human. And if you are trying to conceive and having difficulty, reach out to your healthcare team for advice. Best of luck either way!
- Fertility in people with childhood-onset type 1 diabetes
- Fertility is reduced in women and in men with type 1 diabetes: results from the Type 1 Diabetes Genetics Consortium (T1DGC)
- The Impact of Hypothyroidism on Fertility and Pregnancy
- Association between vascular health and ovarian ageing in type 1 diabetes mellitus
- Assessment of ovarian reserve in patients with type 1 diabetes: a systematic review and meta-analysis
- Evaluation of relationship between HbA1c levels and ovarian reserve in patients with type 1 diabetes mellitus
- Diabetes Mellitus and Infertility: Different Pathophysiological Effects in Type 1 and Type 2 on Sperm Function
- Effects of diabetes mellitus on sperm quality and fertility outcomes: Clinical evidence
- Type 1 diabetes mellitus and sperm quality: A case-control study
- Infertility and pregnancy outcome in an unselected group of women with insulin-dependent diabetes mellitus
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES