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Home › Conditions › Diabetes and fertility
CONDITIONS · DIABETES
Control before conception protects both of you.
Diabetes means blood sugar runs too high, because the body makes too little insulin or cannot use it well. It affects fertility in women and men, and the months before conception are when control matters most.
- Common
- HbA1c blood test
- Both partners checked
- Planned with your physician
- Blood sugar — Measured by HbA1c over 2 to 3 months
- Ovaries — Insulin resistance can stop regular ovulation
- Him — Nerves and blood flow for erection and ejaculation
- Early pregnancy — The baby's organs form in the first weeks
01Can diabetes cause infertility?
Diabetes does not stop most women or men from conceiving, but poorly controlled sugar can make ovulation irregular in women and cause erection, ejaculation and sperm problems in men.
Type 2 diabetes often comes with insulin resistance and extra weight, which can stop regular ovulation, as in PCOS. Type 1 diabetes, if well controlled, usually has little effect on fertility. The bigger risk is not conceiving, but conceiving while sugar is high.
PCOS02Why does sugar control matter before pregnancy?
High blood sugar in the first weeks of pregnancy, when the baby's organs form, raises the risk of miscarriage and birth defects.
Those weeks pass before most people know they are pregnant. That is why control has to come before conception, not after the test is positive. Good control also lowers the risks later in pregnancy, for you and the baby.
Honest note
The NHS advises an HbA1c of no more than 48 mmol/mol (6.5%) before pregnancy if it can be reached safely, and advises against trying while it is above 86 mmol/mol (10%). (What the evidence says)
03How does diabetes affect male fertility?
In men, poorly controlled diabetes can damage the nerves and blood vessels needed for erections and ejaculation, and can lower sperm quality.
Nerve damage can cause retrograde ejaculation, where semen goes back into the bladder instead of out. These problems are common, treatable and private. A semen analysis and a plain conversation are the first steps.
Ejaculation problemsErectile dysfunction04What do we do before you try?
Before trying, we bring HbA1c down with your physician, review every medicine, start high-dose folic acid, and check eyes and kidneys.
Some medicines for blood pressure and cholesterol are not safe in pregnancy and are switched first. Most diabetes tablets are switched to insulin in pregnancy, though metformin is often continued. High-dose folic acid is on prescription, from the time you plan until 12 weeks. Once sugar is in range, fertility treatment goes ahead as your other tests decide.
Honest note
Lifestyle, led by a healthy weight. Then smoking, alcohol, about seven hours of sleep, stress, folic acid, and correcting thyroid, diabetes, blood pressure and vitamin D. (Dr Vani Sundarapandian, Medical Director)
05Can I have IVF with diabetes?
Yes, IVF is possible with diabetes once blood sugar is well controlled, and the plan is shared with your physician.
Sugar is checked during stimulation and early pregnancy. If you had gestational diabetes in an earlier pregnancy, your sugar is tested before trying again, because type 2 diabetes is more likely later. Targets for weight and sugar are set with your doctor, for you.
Does this sound like you?
If any of these fit, plan before you try.
- I have type 1 or type 2 diabetes
- My sugar was high in my last pregnancy
- I've been told I'm pre-diabetic
- I have PCOS and my sugar is borderline
- He has diabetes and erection problems
- We're trying and my HbA1c is high
Sugar normal, but weight is a worry? That is often the bigger lever.
What we do, in order.
- 1
Test both of you
HbA1c for her, sugar and a semen analysis for him.
- 2
Plan with your physician
Sugar control, medicines switched, folic acid started, eyes and kidneys checked.
- 3
Treat what else is found
Ovulation tablets for irregular cycles; help for erection or ejaculation problems.
- 4
IUI or IVF if needed
Once sugar is in range, with checks through stimulation and early pregnancy.
Your first visit
1
Talk
Your diabetes type, medicines, last HbA1c, and any past pregnancy with high sugar. Both partners.
2
Test
HbA1c, the usual fertility tests, and a semen analysis.
3
Plan
A joint plan with your physician: sugar target, medicine changes, folic acid.
4
Treat
Fertility treatment once sugar is ready. Not before.
Questions patients ask
Still unsure? Ask us on WhatsApp — a real person replies.
What should my HbA1c be before trying to get pregnant?
The NHS advises an HbA1c of no more than 48 mmol/mol (6.5%) before pregnancy, if it can be reached without low sugar episodes. Your own target is set with your physician.
Can a diabetic woman get pregnant naturally?
Yes, many women with diabetes conceive naturally. The aim is to conceive when sugar is well controlled, which is why planning comes first.
Does diabetes affect sperm?
Yes, poorly controlled diabetes can lower sperm quality and cause erection and ejaculation problems. A semen analysis shows where he stands.
Which medicines should I stop before pregnancy?
Some blood pressure and cholesterol medicines, and some diabetes tablets, are changed before or early in pregnancy. Never stop a medicine yourself; we review each one with your physician.
I had gestational diabetes last time. Does it matter now?
Yes, gestational diabetes raises the chance of type 2 diabetes later, so your sugar is tested before you try again. It is simple to check and useful to know.
Why do I need a higher dose of folic acid?
Women with diabetes are advised to take high-dose folic acid, on prescription, from planning until 12 weeks, because the risk of neural tube defects is higher. The usual shop dose is not enough.
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CONDITION
Where to next
Insulin resistance, irregular cycles, and what helps.
TESTSemen analysis
His side of the plan, in one test.
TREATMENTOvulation induction
Tablets and scans once sugar is controlled.
TREATMENTTREATMENT · Planned with your physician, when sugar is ready.
Planned with your physician, when sugar is ready.
Plan the months before the pregnancy.
Send us your last HbA1c and your medicines, if you have them. A real person from Dr Vani's team replies on WhatsApp, usually within minutes during clinic hours (Mon to Sat, 9am to 5pm. Sunday closed.).