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Fertility treatment

Diabetes: How does it affect fertility?

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Diabetes and infertility

Scientific research has established that uncontrolled diabetes can affect fertility and reproductive health in both men and women. It is linked to hormonal disruptions, poor sperm quality and DNA damage, often resulting in irregular or absent menstrual cycles in women, while men could find it difficult to achieve and maintain erections.

What effect does diabetes have on fertility?

Diabetes can have different repercussions among women and men in terms of affecting fertility.

In women:

Infections: Women with diabetes are more prone to infections and damage to their reproductive organs, most commonly, the fallopian tubes.

Complications with pregnancy: Uncontrolled blood sugar levels can lead tomiscarriage or congenital defects in the foetus or even to ‘big baby syndrome’ or macrosomia.

Subdued libido: Most women with diabetes would suffer from fatigue, increased anxiety and depression, which could lead todecreased sexual desire. They can also feel pain and discomfort during sex because of decreased vaginal lubrication.

PCOS: Type 2 diabetes and obesity are also linked to PCOS or Polycystic Ovarian Syndrome, a metabolic disorder characterized by an excess of male hormones.

Anti-sperm antibodies: Diabetes can produce antibodies which may attack the sperms and even her eggs.

In men:

Sexual dysfunction: Men with diabetes often find it difficult to maintain an erection leading to infertility.

Decreased libido: Diabetic men also suffer from fatigue, weakness and loss of sexual drive, since certain areas of the brain don’t receive enough glucose, which is the only source of energy.

Damage to sperm DNA: Men with diabetes can experience impaired reproductive potency because of increased nuclear, mitochondrial and DNA damage.

Poor sperm quality: Type 2 diabetes is linked to poor sperm concentration in semen and also sub-par motility. Structural damage to the sperm and its DNA are also commonplace.

How is diabetes-related infertility treated?

A more holistic approach involving the couple’s respective family and medical histories is the ideal strategy. The aim is to achieve better control over the glycemic level and reproductive hormones and functions.

Some of the treatment options available are:

Medications: Treatment approach often startswith medications to stimulate ovulation in women, besides treating infections. Medications (sometimes coupled with hormonal supplements) are also used to treat issues like erectile dysfunction and premature ejaculation in men.

Surgical management: Surgical management often becomes a necessity to treat some cases of PCOS, uterine fibroids, trauma injuries, etc.

Advanced reproductive technologies (ART): For men, ART experts use procedures forsperm retrieval and intracytoplasmic sperm injection. For women, the methods generally deployed are in-vitro fertilization, intrauterine inseminationand assisted laser hatching.

However, it’s not all gloom and doom if you have diabetes and planning to start a family. It just requires early and comprehensive planning involving multiple specialties including endocrinologist, gynecologist and andrologist. The goal is to maintain your blood glucose levels at an optimum range to facilitate conception and maintain pregnancy till full-term. It’s all about cutting risks, watching your weight, eating right and meticulously following the advice of the doctors. Sometimes it will be absolutely necessary to seek help from a fertility expert as well.

Fertility treatment

Fertility Preservation: ‘Preserving’ your dreams of Motherhood

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Fertility Preservation

Breast cancer is regarded as the most prevalent malignancy in women and usually, the incidence is higher among older women, a majority diagnosed post-menopause. However, a large number of young women too are diagnosed with breast cancer during their reproductive lifespan. A lot of these patients experience difficulty conceiving after cytotoxic chemotherapy and/or hormone therapy.

With increasing positive outcomes in breast cancer treatment thanks to rapid advances in methods and techniques in modern medicine, it is becoming more and more relevant to consider fertility preservation in these patients. Fertility preservation is “the process of saving or protecting eggs, sperm, or embryo” to enable a person to use them to conceive in future.

The key to successful fertility preservation in cancer patients is early counseling and a prompt referral to a reproductive specialist. This gives the patients and their spouses/kin adequate time to make an informed decision on an appropriate method of fertility preservation, since there are a whole host of linkages between cancer diagnosis and fertility to consider and it can be really overwhelming.

What are available options of fertility preservation for breast cancer patients?

The currently used methods include: Cryopreservation of embryos; Oocytes cryopreservation; Gonadotropin-releasing hormone agonist treatment before and during chemotherapy; Ovarian transposition.

The most suitable method of fertility preservation is usually arrived at following a threadbare discussion of all the pros and cons between patients and doctors.

The entire process of fertility preservation following a breast cancer diagnosis can be traumatizing and confusing for couples. Men can bank their sperm without much ado, but for women, it’s a little more complicated. Cryopreservation of embryos is a commonly used technique these days for preserving fertility for use in assisted reproductive technology like IVF or in-vitro fertilization.

Who else can benefit from fertility preservation?

Individuals afflicted with certain illnesses or disorders which affect fertility could also benefit from fertility preservation. These include:

  • Those who have been exposed to toxic chemicals
  • Those suffering from endometriosis
  • Those having uterine fibroids
  • Patients needing treatment for an autoimmune disease
  • Those having a genetic disorder affecting fertility
  • Women who push back childbearing

Studies have shown that women diagnosed with breast cancer who have completed their treatment, “had no increased risk of relapse” if they delivered a baby following conception through IVF techniques. Overall, there is “no clear evidence” that ovulation induction or IVF increases the risk of breast cancer. The same studies on breast cancer patients also reveal that pregnancy and childbirth are not known to increase the risk of relapse.

Fertility treatment

Psychological impact of fertility treatment : How to cope with it

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Fertility Treatment

The inability to conceive a child despite trying for long can have a devastating psychological impact, and millions of couples around the world affected by infertility have to deal with this unfathomable sense of loss and grief, leading to great emotional upheavals. It’s not easy to cope with the plethora of critical medical decisions and the uncertainty about outcomes associated with fertility treatment.

Often, it’s the worst life crisis that can confront a couple which, apart from the overwhelming sense of loss, can also trigger anger, guilt and shame. It can lead to depression, anxiety and a terrible feeling of alienation. Just remember that coming to grips with infertility, the subsequent decision to go for assisted reproduction and the psychological impact of the treatment, is not easy and sometimes you will need support from a certified mental health professional. It’s very important to know that you are not alone in this journey.

When should you seek psychological counseling?

Infertility treatmentcould be an emotional rollercoaster for most couples, and feeling overwhelmed is perfectly normal. You need to talk to the treating doctor and counselor in case you are feeling like any of these:

  • Losing interest in normal activities
  • A sense of depression that engulfs you
  • You feel your relationship with your partner and others is on the edge
  • Can’t take your mind off your infertility problem
  • Feel anxious all the time
  • Detect a fall in your efficiency levels
  • Have trouble concentrating
  • Experience difficulty in sleeping
  • Find a change in appetite or weight
  • Have suicidal thoughts
  • Shun company
  • Experience a constant sense of guilt, bitterness or anger

How can counseling help you cope better?

  • The primary goal of the counselor is to help couples cope better with the physical and emotional factors linked to infertility, and the medical treatments.
  • Choosing the right medical treatment or exploring other family-building options can be a tough decision where your infertility specialist and the counselor can play a big role.
  • A counselor can teach you deal with stress, anxiety or depression by using problem-solving techniques which can help you cope better with grief, fear, and other negative emotions.
  • We all have in-built coping skills which sometimes take a backseat when a sense of grief and futility overwhelms us. Therapy prior to and during the treatment can help in re-charging those skills and help in achieving a place of positivity and hope.
  • These exercises could also often turn the life crisis of infertility on its head to help the individual/couple embrace rewarding pursuits for progress, armed with more clarity of thought.
  • Sometimes, the hormones used in infertility treatment affect the mood of the patient, prior knowledge and understanding can help a person to cope better. Counselingby the treating doctor and the therapist is a vital part of infertility treatment.

    • What can I do on my own to cope better?

    The journey through IVF could be very tough, and there’s no right or wrong way to feel about it. Emotions vary from person to person. However, you can try these simple steps to keep your negative emotions in check:

    Don’t fight your feelings: Acknowledge your feelings and emotions, don’t try to suppress or deny them, no matter how intense and destabilizing they are.

    Stay in the moment: Try and perceive your emotions as a passing phenomenon, even if they are particularly painful. Tell yourself, “Tomorrow will be better”.

    Talk to people: Opening up about your feelings and secret fears to someone you can lean on can really help. It could be your partner, a family member or a close friend or colleague. It strengthens the sense of not being alone in your fertility journey.

    Focus on what you can control: There are only certain things which are in your grasp, like when you would like to start a treatment cycle, the length of break between cycles, or when to seek another opinion. Try to stay with these tangibles and remember to plan for the short term and keep your plans flexible.

    Stay informed: Get clear understanding of critical issues like treatment cost, success rates based on your specific circumstances and all the different treatment options available. This will help you make better choices and more confident about meeting challenges head-on.

    Medicines might help: For some people, antidepressant medications may be required for the treatment of depression and anxiety. Most of these can be safely used in pregnancy as well.

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Not Convinced? Get a Second Opinion about Your Fertility Treatment

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Fertility Treatment

Misha and Manoj were hoping to expand their family, but after trying for a year and a half, they realized there was a problem in conceiving naturally. They consulted a Doctor who recommended some tests. The results revealed that Misha had a blocked Fallopian tube and severely diminished ovarian reserve of 0.08 (extremely low egg supply) at 30. 

The recommendation was donor eggs, and as soon as possible, as her biological clock was ticking. On probing further as to why using donor eggs was the only way forward, the doctor refused to provide a convincing explanation. Misha got her sister tested as a donor but could not accept that her baby would not be biologically hers.

Something in the couple’s hearts told them that they needed a second opinion so they decided to schedule a consultation at a well-known fertility clinic after a friend highly recommended, they go there.

Misha was scared to death, felt defeated, and guilty as having a child was something, she had always taken for granted. But the fertility specialist made the couple feel comfortable right from the start. He took the time to explain to them what was happening and what their options were.

Misha and Manoj took their time and decided to proceed with IVF, one of the primary options suggested by the fertility specialist. They went through three IVF cycles. Cycle 1 was cancelled due to no viable embryos and cycle 2 resulted in a negative pregnancy test, but cycle 3 was different.

The third cycle yielded only two eggs at the retrieval. Although discouraged, both Misha and Manoj tried to remain optimistic. After all, it only takes one, right? Miraculously, both eggs fertilized normally and continued to grow. On day 3, both embryos were transferred and 2 weeks later, they received the news they had been waiting on for a year and a half – Misha was pregnant. The fertility journey, at last, felt so perfect and incredible.

Blessed with their miracle child, Madhur, the couple owes it all to the second opinion they’d taken.

If you are someone undergoing fertility treatment or have been thinking of seeking the second opinion then, here’s more about when you should consider seeking a second opinion and how to go prepared for the visit.

When should I think about seeking a second opinion?

If you’re not sure whether it’s time to look further afield, here are some of the most common reasons why you might seek a second opinion about your fertility treatment.

You’ve been under the care of your primary care doctor or OB-GYN and want to explore more specialized help

Many patients struggling with fertility first seek help with their own doctor. Your primary physician or gynaecologist may ask you to take some preliminary tests, recommend lifestyle changes or fertility therapies such as acupuncture, or prescribe you a fertility medication. If you’ve explored some or all of these options with your doctor and still haven’t gotten pregnant, it may make sense to seek a second opinion from a fertility expert.

You suspect that there may be more to your infertility diagnosis

While many cases of infertility are due to unknown causes, undergoing a thorough diagnosis is important. If you are worried that something has been missed or feel that more investigation is necessary, it may be a good idea to seek a second opinion.

You have had several unsuccessful IVF cycles with your current clinic

The truth is that some IVF cycles fail, even at the most popular clinics. The human reproductive system is complex and each patient is unique, so each fertility journey takes time to complete. However, if you have undergone three or more unsuccessful rounds of IVF and feel that you’re not getting any closer to good news, it could be time to look elsewhere.

You want to try something new that your current clinic can’t offer

Reproductive endocrinology is a rapidly evolving field and new research, technology, and best practices are constantly evolving. In your own research, if you find a new test or treatment you would like to explore and if your current clinic is not in a position to offer you the same, you may need to look for another clinic that can help you ensure that you have tried everything.

You have concerns about your relationship with your team

The rapport you share with your fertility specialist and treatment team is important. Yes, they are the experts, and you trust them to help you make the right choices, but you should also be informed about the decisions being made about your treatment.

  • You must always be comfortable asking questions and voicing concerns
  • Check if you are presented with just one option for treatment or
  • If the specialist is not taking the time to explain the treatment plan and the reasons behind it
  • If they are not informing you of possible risks

These could be signs to switch fertility specialists.

Your doctor recommends that you seek a second opinion

Sometimes, it may be a doctor who suggests seeking a second opinion. It does not indicate that yours is a difficult case. Your doctor may know a colleague who has more specific knowledge and experience in dealing with issues you are facing, or a clinic that has a higher success rate with patients who have similar case histories. An honest doctor will help you find the best possible treatment, even if it means handing over your case to another expert.

How should I choose which clinic to visit next?

Finding the right fertility clinic can be challenging, even if you’ve already been through the process before. While it can be a struggle to think about starting over or seeking a second opinion from a new fertility specialist or clinic, remember that you have knowledge and resources now that you did not have the first time.

Ask your doctor

If you have a good relationship with your current physician, this is something you can talk about with them. Ask them for a recommendation. At this point, they know your case and needs, and they may be able to refer you to someone who can move your treatment forward.

Reach out to your network

You are not alone in your experience of infertility or to get the answers you need. If you are not part of a support group or community of individuals undergoing fertility treatment, you can try exploring those resources. Talking to others who have the first-hand experience of different clinics and fertility specialists can be helpful.

Arrive prepared

There are some things you can do to make the visit for a qualified second opinion smoother.

  • Carry a copy of medical records and test results before visiting a fertility specialist
  • Bring the notes you have taken at your previous clinic visits
  • Prepare a list of questions to ask
  • If there are treatment procedures you would like to try, don’t hesitate to bring them up during the visit.

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