6 Questions Women with Diabetes Ask About Conception

Women with Type-1 diabetes face unique challenges when it comes to conception—but the challenges are not insurmountable. You may have tried time and time again to get pregnant without success.[1] You may also have lost pregnancies. We want to let you know that with proper planning and the latest medical technology, there is reason to hope for success in delivering a healthy baby.

Success Rates for Women with Type-1 Diabetes

Here at the Southern California Reproductive Centers (SCRC), we’ve successfully helped women with Type-1 diabetes deliver healthy babies.[2]

That’s why we say you have reason to hope. We offer more than 25 years of experience in fertility practice. Combined with our state-of-the-art in-house embryology lab, on-site surgery center, and the most advanced IVF technologies available, we offer the best fertility support medical science has to offer. Plus, you have the attention, partnership, and care of our compassionate physicians.

“Our group has been here since 1999, and we have a lot of wonderful teammates and we work very closely with,” said Dr. Carolyn Alexander, M.D., F.A.C.O.G., one of SCRC’s experienced physicians. “We work collaboratively and provide very individualized care for each of our patients. We go the extra mile to get healthy embryos and get you a healthy baby,” she said.²

Dr. Alexander answers questions and gives in-depth information about women with Type-1 diabetes and fertility in a recent webinar. View the webinar below.

Plan Ahead for Success

The American Diabetes Association offers tips for success throughout your pregnancy.[3]

Preconception

Talk to your health care provider a few months before starting to conceive
Get your blood glucose checked and discuss results with your endocrinologist for optimization pre-pregnancy
If you do not have diabetes but have risk factors, get screened for Type-2 diabetes
If you are overweight, focus on weight loss before you conceive
Check thyroid function to make sure it is at a proper level
See your ophthalmologist if you have or are at risk for retinopathy
Get screened for diabetic kidney disease
Line up your pregnancy providers

First Trimester

Continue taking your diabetes medication, but be aware that the dosage may vary during pregnancy
Monitor your glucose when you wake, before eating, an hour or two after meals or as directed by your doctor
Eat a well-balanced diet and work with an expert if needed
Taking baby aspirin daily after 12 weeks may lower your risk of preeclampsia. Check with your doctor first

Second Trimester

Focus on eating about 300 more calories a day above your normal healthy diet during your second and third trimesters
Stay active with a goal of at least 150 minutes of moderate activity per week
Avoid contact sports, activities where you might fall, activities that raise your temperature too high and heavy lifting. Consult your doctor if you’re unsure
Aim to gain no more than 25-30 pounds during your pregnancy if you started with a normal BMI
Continue to monitor your glucose; insulin requirements may increase during pregnancy
Go for recommended testing, including a fetal echocardiogram at 18 weeks, ultrasounds and an anatomy scan at 18-22 weeks

Third Trimester

Work with your doctor to make sure you are getting enough insulin. You may need as much as double your normal amount by late in your third trimester
Your doctor will likely ask you to get a growth scan every four weeks to monitor the baby’s size
The growth scan will monitor the amniotic fluid to make sure the level isn’t too high
At 30-32 weeks, you’ll start getting nonstress tests or a biophysical profile—a combination of a nonstress test and an ultrasound
You may be induced early, at 37 or 38 weeks, especially if the baby show signs of stress

The U.S. Centers for Disease Control and Prevention (CDC) offers similar tips for women with diabetes.[4]

Plan for pregnancy
See your doctor early and often
Eat healthy foods
Exercise regularly
Take medications and insulin as directed
Keep your blood sugar controlled
Monitor your blood sugar often

6 Questions Women with Type-1 Diabetes Ask About Conception

1) Does Type-1 diabetes have an impact on egg quality and quantity?

With diabetes, especially Type-1, there is an increased risk of anti-ovarian antibodies that can affect ovarian function and reserve. The test for this is not perfect because antibodies can ebb and flow. However, when these are high, egg quality can shift at a younger age than typically expected.²

Having high hemoglobin A1C causes inflammatory cytokines, and that can impact egg quality as well. It is important to keep your hemoglobin A1C as healthy as possible if you have PCOS, Type-1, or Type-2 diabetes.²

2) How does insulin resistance affect fertility?

Insulin resistance can impact the maturity of the egg that is ovulated. Insulin growth factor-1 receptors are in the ovaries, especially in the cortex, which is in the center of the ovary. The more activation there is, the more cell hyperplasia there is inside the ovary. Cell hyperplasia is increased cell production in normal tissue. This can look like PCOS, and the follicles get pushed out to the perimeter.²

Some of our younger patients who are trying to get pregnant feel frustrated because they are not finding success. Oftentimes, we can give a gentle push to mature the follicle to help our diabetic patients get pregnant.²

3) What is the importance of TSH and A1C levels going into fertility treatments?

It is important to check your thyroid and keep your TSH levels below 2.5 if possible. It is common for women to exhibit some clinical hypothyroidism with TSH that is a little high. The TSH is produced by your pituitary gland, and it tells your thyroid to make thyroxine or free T4.²

If your TSH starts to go up and your thyroid doesn’t listen, it starts to push you toward hypothyroidism, which can cause an increased risk of miscarriages, egg quality issues, weight gain, fatigue, dry skin, sleepless nights, memory issues and constipation.²

The perfect hemoglobin A1C is difficult to achieve with Type-1 diabetes. It is hard to bring down, and it’s important for it not to get too low because it can cause very low lows. For Type-1 diabetic patients, we rely on an endocrinologist to help. With Type-2, we keep A1C as low as it can go. With insulin-resistant PCOS patients, we try to keep it below 5.7 before they try to get pregnant, especially in the case of an embryo transfer.²

4) What should be done differently for diabetics, especially those with recurring losses?

The first step is to get good eggs and embryos. Once good embryos are frozen, one can be implanted during natural ovulation, or we can create a medicated cycle with oral estrogen and intramuscular progesterone.²

If you have a limited number of embryos, it can aid success to try a mock endometrial receptivity assay test. You take the medicines for 18 days, but we don’t implant the embryo at that point. We then do a biopsy to check for the receptors that help the embryo to implant. This gives us more information about how your body is responding and what we may need to do to improve your chances of success.²

5) When should I reach out to a reproductive specialist vs. my gynecologist, and what will they need from me?

If you are 35 or over, we encourage you to try for six months to get pregnant if you’re having regular menstrual cycles and your partner has no health or fertility issues. If you are not able to get pregnant after six months, it is important to check your ovarian reserve and your fallopian tubes and for your partner to have a semen analysis.²

If you are under 35, having regular periods and are otherwise healthy, we recommend trying for a year. If you do not get pregnant during that time, it is important to get an evaluation.²

It is helpful for your reproductive specialist to have your medical records. They will want to see your hemoglobin A1C trends, body mass index, thyroid levels and pap smear results. If you’re over 40, it is helpful to see an up-to-date mammogram as well.²

6) How do I find a reproductive specialist in my area who understands Type-1 diabetes?

Finding a physician is a very personal decision because this is a very personal journey. You might find a physician locally by a referral from a friend or by searching the internet for a qualified practice.

Once you have an appointment, have your questions ready and ask them. If more questions come up, ask more. If you have information you’ve learned along the way, bring that to the table. Ask about their success rate, how long they’ve been in business. Find out about their lab. Having an on-site lab is very important for responsiveness and quality.

SCRC is Here to Help

The physicians at SCRC understand Type-1 diabetes, and our combination of medical science and personal physician support has resulted in excellent success with diabetic patients who want to have children. You can schedule an appointment at our offices in Los Angeles/Beverly Hills, Santa Barbara or Pasadena.

"It is a joy to work here,” said Dr. Alexander. “We’re always reading articles and staying as up-to-speed as we can. We are happy to take care of you. Since COVID, we do a lot of video calls. That helps patients because they don’t have to park and hurry in. We can talk for 45 minutes without having to wear a mask or goggles,” she said.

We have had diabetic patients come in heartbroken because they desperately want to start or grow their family, and we share their happiness when they conceive and deliver a healthy baby. We’d love to help you.