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December 20, 2003

Family Planning

Question from San Diego, California, USA:

I've noticed quite a few questions recently from women undergoing IVF and dealing with Type 1 diabetes. Is there any connection between Type 1 diabetes and infertility? I asked this question over 2 years ago and you answered, "As long as you are ovulating and your glucose is in good control, then fertility should not be directly impaired by diabetes." Has anyone � ever � done any type of research regarding infertility and Type 1 diabetes? I have several non-diabetic friends who suffer from polycystic ovarian syndrome (PCOS) who were prescribed metformin and became pregnant after years of trying on their own as well as with medical assistance (including IVF). From my on-line research, I understand the metformin helps with insulin resistance, and wonder if it wouldn't also help those of us with Type 1. Apparently, the "jury�s still out" (see DTeam question) on whether this is an option for Type 1s, but would trying metformin do any harm? I am now 30 years old, have had Type 1 for almost 20 years, and am in great health (HbA1cs around 6%). It took us 5 years, 3 IVFs, and more money than I can count to finally be blessed with twins (all fertility tests continue to come back "normal"). I guess I'm looking for a quicker, less expensive way to get a sibling for my children!

Answer:

Congratulations on the twins. As I have mentioned before, I am not aware that diabetes per se causes infertility although women with PCOS and impaired glucose tolerance can have abnormal ovulation. Hormonal regulation is very complex and there may be indirect effects on the ovaries and tissues of the uterus that could affect reproduction. I do not think that the exact mechanism that leads to improved ovulation with metformin in Type 2 diabetes is completely known. However, you should understand that infertility is not my area of expertise and a better answer would come from your reproductive endocrinologist. I do know that some diabetologists are using oral hypoglycemic agents in combination with insulin. The theory is that less insulin may be needed to achieve good glucose control. This approach may improve ovulation as well. As you know, infertility can be due to a variety of causes. So even if the issues of diabetes are resolved other factors may be at play.

OWJ