As the rates of Type II diabetes are rising every year in the U.S., there are many infertility specialists that are are beginning to look toward this health issue as a main cause of some otherwise unexplained infertility cases that they see. Management of Diabetes and the symptoms associated with it are crucial to fertility treatment success and a healthy pregnancy.
Listen in as Alan Martinez, MD discusses the correlation between fertility and diabetes.
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Management of Diabetes and Infertility
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Learn more about Dr. Alan Martinez
Alan Martinez, MD
Dr. Alan Martinez is a specialist in Reproductive Endocrinology and Infertility. He completed his fellowship training at the University of Cincinnati Medical Center and is a board eligible physician in Obstetrics and Gynecology, and Reproductive Endocrinology. Dr. Martinez has expertise in hysteroscopic and advanced laparoscopic surgery. After graduating with distinction with a B.S in Biology and B.A. in Psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California Los Angeles. He completed his Obstetrics and Gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School.Learn more about Dr. Alan Martinez
Transcription:
Management of Diabetes and Infertility
Melanie Cole (Host): With the rates of Type II diabetes rising every year in the U.S., infertility specialists are beginning to look toward this health issue as a main cause of some otherwise unexplained infertility cases that they see. My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. So, with this rising rate of Type II diabetes, if a woman comes to you and she already has diabetes, what do you tell her about her chances for fertility treatments?
Dr. Alan Martinez (Guest): Well, I explain to her first that it is absolutely necessary to manage your diabetes and have it under well-controlled levels previous to attempting any sort of pregnancy. So, we will counsel patients that present to us and their diabetes is not well controlled to seek out their physician for management of the diabetes and then we discuss the fertility treatments and the implications of having the diabetes as you try to conceive.
Melanie: So, is it more difficult? Explain the correlation between diabetes and fertility.
Dr. Martinez: Your body has to regulate its sugar level and with diabetes, the body does not do that. And so, you have insulin resistance which causes elevated blood sugars. Those blood sugars can directly affect a woman’s ability to conceive. It can be related to spontaneous miscarriages and spontaneous difficulties with conceiving, as well as problems with uncontrolled diabetes when a woman does get pregnant. And so, both of those need to be considerations in these fertility patients that present to our office.
Melanie: Do the medications that control diabetes interfere with fertility?
Dr. Martinez: No, they do not. There are a certain group of medications that, when you talk to your physician about this and management of diabetes that they know you’re getting pregnant, they’ll put you on certain medications that are cleared and not harmful to any potential pregnancy or developing a baby. So, your endocrinologist, your medical endocrinologist or the individual who is managing the diabetes, will know that and put you on appropriate medication. If your sugars are maintained under the guidance of these medications, then there are no increased problems with the development of the baby or getting pregnant.
Melanie: So, Dr. Martinez, pregnant women who have never had diabetes before, but who might have high blood glucose, and then you might tell them that they have gestational diabetes, what is that?
Dr. Martinez: That is a lower level of insulin resistance where your body is taking care of sugar loads through food, through stresses, but you’re not overtly diabetic, and so it’s important because if you are thinking about getting pregnant or you’re already pregnant, managing the diabetes can directly relate to the health of the baby. It’s directly related to positive pregnancy outcomes if the sugars are maintained well within a normal level. So, it becomes very important to manage this.
Melanie: And how is it usually managed?
Dr. Martinez: Well, we start out with diet counseling as well as exercise. That can always help out any pre-diabetic or diabetic patients as well as weight management. That is a big thing. So, you will receive counseling on that. We’ll talk about that and then, if those things fail and the blood sugars are elevated, then it’s an indication to undergo a screening to see exactly where the blood sugars are and if medications are warranted. And, most of the medications are oral medications that help your body deal with glucose levels and sugar levels better. And then, if those fail, then that progresses to injections of insulin or various regimens of insulin in order to control the diabetes.
Melanie: Women hear you say weight management in pregnancy and they think right away to themselves, “I thought I wasn’t supposed to watch my weight during pregnancy.” It’s a little confusing for women. What do you tell them about that?
Dr. Martinez: Yes, and this is a major concern because the estimates now from the American College of Obstetricians and Gynecologists is that over 50% of women are overweight in the United States and many of them were overweight and or obese prior to pregnancy. It’s directly related to miscarriages, difficulty conceiving, the likelihood that you’re going to ovulate and release and egg and get pregnant and stay pregnant. So, when we talk about weight gain, depending upon where you’re at, if you’re considered to be overweight, obese, or morbidly obese, which is the very high, high elevation of body weight, then there are specific criteria of the weight that that is supposed to be gained in pregnancy. So, if you start out heavier, or at a higher weight, then the recommendations are going to be that you’re to gain less weight in the pregnancy. The bottom line is weight gain in pregnancy is there, for the most part, is even if a woman is not gaining any weight, as long as the fetus is growing a normally, and we can measure that from the height of the uterus called the “fundal height” and your doctor would do that, then it’s not an indication or concern. If the height or the development of the baby starts to decrease to a certain amount, then that’s when the consideration of weight gain and altering diet and those sort of things kind of come into play.
Melanie: If somebody does already have Type II diabetes, how do you work with them in fertility treatments, Dr. Martinez? What do you want them to know and do as they’re going through these treatments?
Dr. Martinez: Well, as I mentioned before, I would like you to get your diabetes under control and we can measure your overall sugar levels for the last three months with something called the “hemoglobin A1C”. So, it’s important to have that below a certain threshold level so that you have good management of your diabetes. This is only going to help as you proceed through the infertility evaluation and treatment. And then, we will want to maintain a healthy lifestyle, so eating a healthy balanced diet, as well as some daily moderate exercise, all of these things will benefit patients and we always discuss that as part of a whole body wellness previous to any sort of infertility treatment.
Melanie: Is exercise good for women while they’re going through infertility treatment?
Dr. Martinez: Yes, mild to moderate exercise is. It depends on what treatment you’re going through, but if you already have an exercise regimen that you’re undergoing and your body is used to that level, then oftentimes we do not have to make any changes in the any exercise regimen. With that being said, some of our more advanced infertility treatments, such as in-vitro fertilization, where we need to aggressively stimulate the ovaries to make eggs, that can sometimes come along with decreases in recommendations of types of exercise and intensity because women who are going to those treatments, they may need to dial back things a bit.
Melanie: So, wrap it up for us, Dr. Martinez, and what an interesting topic. Explain to the listeners about that correlation between diabetes and treatments for fertility and what would you really want them to know?
Dr. Martinez: In and out of pregnancy, you always want to try to maintain your blood sugars and take care of any pre-diabetes or diabetes you may have. It’s important to have a healthy lifestyle, a healthy diet, maintain your weight at a good level. If that doesn’t work, then medications can help you out, but it’s very important to address these issues, optimize your blood sugars, and that will best ensure that you’re able to achieve pregnancy, and then grow and maintain a healthy pregnancy with delivery of a healthy infant. So, that’s our recommendation and if we can help you in any way at the Reproductive Science Center of New Jersey, we would love the opportunity to do that.
Melanie: Thank you so much for being with us today listening to Fertility Talk with RSCNJ - The Reproductive Science Center of New Jersey. For more information, you can go to www.fertilitynj.com. That’s www.fertilitynj.com. This is Melanie Cole. Thanks so much for listening.
Management of Diabetes and Infertility
Melanie Cole (Host): With the rates of Type II diabetes rising every year in the U.S., infertility specialists are beginning to look toward this health issue as a main cause of some otherwise unexplained infertility cases that they see. My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. So, with this rising rate of Type II diabetes, if a woman comes to you and she already has diabetes, what do you tell her about her chances for fertility treatments?
Dr. Alan Martinez (Guest): Well, I explain to her first that it is absolutely necessary to manage your diabetes and have it under well-controlled levels previous to attempting any sort of pregnancy. So, we will counsel patients that present to us and their diabetes is not well controlled to seek out their physician for management of the diabetes and then we discuss the fertility treatments and the implications of having the diabetes as you try to conceive.
Melanie: So, is it more difficult? Explain the correlation between diabetes and fertility.
Dr. Martinez: Your body has to regulate its sugar level and with diabetes, the body does not do that. And so, you have insulin resistance which causes elevated blood sugars. Those blood sugars can directly affect a woman’s ability to conceive. It can be related to spontaneous miscarriages and spontaneous difficulties with conceiving, as well as problems with uncontrolled diabetes when a woman does get pregnant. And so, both of those need to be considerations in these fertility patients that present to our office.
Melanie: Do the medications that control diabetes interfere with fertility?
Dr. Martinez: No, they do not. There are a certain group of medications that, when you talk to your physician about this and management of diabetes that they know you’re getting pregnant, they’ll put you on certain medications that are cleared and not harmful to any potential pregnancy or developing a baby. So, your endocrinologist, your medical endocrinologist or the individual who is managing the diabetes, will know that and put you on appropriate medication. If your sugars are maintained under the guidance of these medications, then there are no increased problems with the development of the baby or getting pregnant.
Melanie: So, Dr. Martinez, pregnant women who have never had diabetes before, but who might have high blood glucose, and then you might tell them that they have gestational diabetes, what is that?
Dr. Martinez: That is a lower level of insulin resistance where your body is taking care of sugar loads through food, through stresses, but you’re not overtly diabetic, and so it’s important because if you are thinking about getting pregnant or you’re already pregnant, managing the diabetes can directly relate to the health of the baby. It’s directly related to positive pregnancy outcomes if the sugars are maintained well within a normal level. So, it becomes very important to manage this.
Melanie: And how is it usually managed?
Dr. Martinez: Well, we start out with diet counseling as well as exercise. That can always help out any pre-diabetic or diabetic patients as well as weight management. That is a big thing. So, you will receive counseling on that. We’ll talk about that and then, if those things fail and the blood sugars are elevated, then it’s an indication to undergo a screening to see exactly where the blood sugars are and if medications are warranted. And, most of the medications are oral medications that help your body deal with glucose levels and sugar levels better. And then, if those fail, then that progresses to injections of insulin or various regimens of insulin in order to control the diabetes.
Melanie: Women hear you say weight management in pregnancy and they think right away to themselves, “I thought I wasn’t supposed to watch my weight during pregnancy.” It’s a little confusing for women. What do you tell them about that?
Dr. Martinez: Yes, and this is a major concern because the estimates now from the American College of Obstetricians and Gynecologists is that over 50% of women are overweight in the United States and many of them were overweight and or obese prior to pregnancy. It’s directly related to miscarriages, difficulty conceiving, the likelihood that you’re going to ovulate and release and egg and get pregnant and stay pregnant. So, when we talk about weight gain, depending upon where you’re at, if you’re considered to be overweight, obese, or morbidly obese, which is the very high, high elevation of body weight, then there are specific criteria of the weight that that is supposed to be gained in pregnancy. So, if you start out heavier, or at a higher weight, then the recommendations are going to be that you’re to gain less weight in the pregnancy. The bottom line is weight gain in pregnancy is there, for the most part, is even if a woman is not gaining any weight, as long as the fetus is growing a normally, and we can measure that from the height of the uterus called the “fundal height” and your doctor would do that, then it’s not an indication or concern. If the height or the development of the baby starts to decrease to a certain amount, then that’s when the consideration of weight gain and altering diet and those sort of things kind of come into play.
Melanie: If somebody does already have Type II diabetes, how do you work with them in fertility treatments, Dr. Martinez? What do you want them to know and do as they’re going through these treatments?
Dr. Martinez: Well, as I mentioned before, I would like you to get your diabetes under control and we can measure your overall sugar levels for the last three months with something called the “hemoglobin A1C”. So, it’s important to have that below a certain threshold level so that you have good management of your diabetes. This is only going to help as you proceed through the infertility evaluation and treatment. And then, we will want to maintain a healthy lifestyle, so eating a healthy balanced diet, as well as some daily moderate exercise, all of these things will benefit patients and we always discuss that as part of a whole body wellness previous to any sort of infertility treatment.
Melanie: Is exercise good for women while they’re going through infertility treatment?
Dr. Martinez: Yes, mild to moderate exercise is. It depends on what treatment you’re going through, but if you already have an exercise regimen that you’re undergoing and your body is used to that level, then oftentimes we do not have to make any changes in the any exercise regimen. With that being said, some of our more advanced infertility treatments, such as in-vitro fertilization, where we need to aggressively stimulate the ovaries to make eggs, that can sometimes come along with decreases in recommendations of types of exercise and intensity because women who are going to those treatments, they may need to dial back things a bit.
Melanie: So, wrap it up for us, Dr. Martinez, and what an interesting topic. Explain to the listeners about that correlation between diabetes and treatments for fertility and what would you really want them to know?
Dr. Martinez: In and out of pregnancy, you always want to try to maintain your blood sugars and take care of any pre-diabetes or diabetes you may have. It’s important to have a healthy lifestyle, a healthy diet, maintain your weight at a good level. If that doesn’t work, then medications can help you out, but it’s very important to address these issues, optimize your blood sugars, and that will best ensure that you’re able to achieve pregnancy, and then grow and maintain a healthy pregnancy with delivery of a healthy infant. So, that’s our recommendation and if we can help you in any way at the Reproductive Science Center of New Jersey, we would love the opportunity to do that.
Melanie: Thank you so much for being with us today listening to Fertility Talk with RSCNJ - The Reproductive Science Center of New Jersey. For more information, you can go to www.fertilitynj.com. That’s www.fertilitynj.com. This is Melanie Cole. Thanks so much for listening.