Insulin resistance affects approximately 1 in 4 adults worldwide. This metabolic condition occurs when your body's cells don't respond effectively to insulin, which leads to elevated blood sugar levels and a cascade of hormonal changes that can impact reproductive health.
The connection between insulin resistance and fertility is both complex and well-documented. Research shows that insulin resistance can contribute to:
- Disruptions in ovulation and hormone production
- Challenges in getting pregnant
- Pregnancy complications
- Metabolic conditions in both parent and child
If you’re navigating fertility challenges, addressing insulin resistance may improve your chances of pregnancy and healthy birth outcomes. We’ll help you understand the relationship between insulin resistance and fertility in this article.
Key takeaways
- Insulin resistance is common among people with fertility challenges. It affects approximately 20.5% of women experiencing infertility, 35-80% of people with PCOS, and has a significant impact on male fertility outcomes as well.
- It can cause infertility in multiple ways by disrupting ovulation, affecting egg and sperm quality, interfering with hormone production, and reducing the chances of successful embryo implantation.
- Certain groups are at higher risk, including people with PCOS, obesity, or a family history of metabolic disorders.
- Diagnosis involves blood tests, including A1C, fasting glucose, fasting insulin, and oral glucose tolerance tests to measure how well your body processes sugar.
- Treatment combines lifestyle changes and medical interventions, such as exercise, healthy eating, weight management, stress reduction, and medications like metformin when appropriate.
- Early intervention improves outcomes. Addressing insulin resistance before trying to get pregnant can improve fertility success rates and reduce pregnancy complications.
- It's often reversible. With consistent lifestyle changes and proper medical care, many people can significantly improve their insulin sensitivity and fertility outcomes.
What is insulin resistance?
Insulin is a hormone produced by your pancreas that helps your cells absorb glucose (i.e. sugar) from your bloodstream for energy. When you have insulin resistance, your cells become less responsive to insulin's signals, which forces your pancreas to produce increasingly higher amounts of insulin to maintain normal blood sugar levels.
Several factors can contribute to the development of insulin resistance, including:
- Genetics
- Excess weight (particularly around the midsection)
- Physical inactivity
- Poor diet
- Chronic stress
- Certain health conditions such as high blood pressure or Cushing’s syndrome
Common symptoms include:
- Increased hunger or thirst
- Fatigue
- Difficulty concentrating
- Frequent urination
- Darkened skin patches (acanthosis nigricans) around the neck, armpits, or groin
Studies indicate that insulin resistance affects approximately 20.5% of women with fertility challenges, even those without polycystic ovary syndrome (PCOS). Additionally, research shows that insulin resistance has a prevalence of 35-80% among people with PCOS, one of the leading causes of infertility in women.
Can insulin resistance cause infertility?
Yes, insulin resistance can indeed cause infertility through several interconnected mechanisms. Insulin resistance may increase the risk of female infertility by:
- Activating oxidative stress
- Interfering with energy metabolism
- Affecting oocyte development, embryo quality and endometrial tolerance
- Impacting hormone secretion and embryo implantation
Increased production of androgens
In women, insulin resistance often leads to increased production of androgens (male hormones) by the ovaries. These elevated androgen levels can interfere with normal ovulation and make it difficult to get pregnant. The condition is closely linked to PCOS, which affects 6-20% of women of reproductive age worldwide, depending on the diagnostic criteria used.
Affects on implantation
Insulin resistance also affects the endometrium (uterine lining), and potentially makes it less receptive to embryo implantation. The chronic inflammation associated with insulin resistance can further compromise egg quality and overall reproductive function.
Impact on sperm motility
For men, insulin resistance is significantly linked to fertility outcomes, with research showing that men with insulin resistance had over 37 times lower odds of achieving normal sperm motility compared to those without the condition.
How does insulin resistance affect fertility?
Insulin resistance affects fertility through multiple pathways that impact every stage of the reproductive process. The primary mechanism involves disruption of the hypothalamic-pituitary-ovarian axis, which controls hormone production and ovulation.
Disrupting menstrual cycles
When insulin levels remain chronically elevated, they can interfere with the production of sex hormone-binding globulin (SHBG), a protein that helps regulate hormone levels. Lower SHBG levels result in higher levels of free androgens, which can suppress ovulation and disrupt menstrual cycles.
Inflammation’s impact on eggs and embryos
In addition to irregular menstrual cycles, people with insulin resistance often experience a longer time to pregnancy and an increased risk of pregnancy loss. The condition contributes to chronic low-grade inflammation throughout the body, including in reproductive tissues. This can compromise egg quality and reduce the success of embryo implantation.
Other risks and complications
During pregnancy, insulin resistance increases the risk of gestational diabetes, hypertensive disorders such as preeclampsia, and other complications that can affect both parental and fetal health.
Who is most at risk for infertility from insulin resistance?
While insulin resistance can impact anyone, certain groups face higher risks due to genetic, lifestyle, and medical factors. If one of these categories apply to you, you may benefit from early screening and intervention on your fertility journey.
Individuals with PCOS
Studies show that 35-80% of people with PCOS also have insulin resistance, regardless of their weight. PCOS itself is an endocrine disorder, and characterized by insulin resistance, irregular periods, and elevated androgen levels. The condition creates a cycle where insulin resistance worsens PCOS symptoms, which in turn can worsen insulin resistance.
Individuals with obesity
Excess weight significantly increases the risk of developing insulin resistance. When people gain weight, their fat tissue releases substances that interfere with how insulin works in the body. Enlarged fat tissue also sends fatty acids to other organs like the liver and muscles, where they can disrupt normal insulin function. This creates a situation where the body becomes less responsive to insulin's signals.
Family history of insulin resistance
People with family members who have Type 2 diabetes, metabolic syndrome, or PCOS are at increased risk. While you can’t change your genetic predisposition to insulin resistance, being aware of your family history allows for earlier screening and preventive measures for both men and women.
Insulin resistance and infertility: Diagnosis
While there isn't a direct test for insulin resistance, your care provider can identify the condition through blood tests that measure how well your body processes glucose. They will also typically ask about your medical history, and recommend testing if you're age 35 or older, or if you have excess weight along with other risk factors for metabolic disorders.
The main diagnostic tests include:
- A1C test: Measures your average blood glucose levels over the past 3 months
- Fasting plasma glucose (FPG) test: Shows your blood glucose level after fasting
- Fasting insulin test: Shows your insulin level after fasting
Oral glucose tolerance test (OGTT): Measures how your body processes glucose over time, though this test takes longer and is more complex to administer
Your care provider may also check cholesterol and triglyceride levels, as these fat levels in your blood can increase when you have insulin resistance, or check hormone levels like testosterone or luteinizing hormone to understand how insulin resistance might be affecting your reproductive system.
How to treat insulin resistance to improve fertility
Fortunately, there are a variety of ways to approach insulin resistance infertility treatment, and improve both insulin sensitivity and reproductive outcomes.
Lifestyle modifications
Movement, food, and weight management form the foundation of insulin resistance treatment. Regular physical activity, particularly a combination of aerobic exercise and strength training, can dramatically improve insulin sensitivity. Even modest amounts of exercise, such as 30 minutes of brisk walking five days per week, can make a meaningful difference. Exercise positively impacts fertility in both men and women as well.
Dietary changes should focus on choosing foods that don't cause rapid spikes in blood sugar. A low-glycemic diet emphasizing whole grains, lean proteins, healthy fats, and plenty of vegetables can help stabilize insulin levels. The Mediterranean diet pattern has shown particular promise for improving insulin sensitivity. Optimizing nutrition is important for fertility too.
Supplements like inositol can help improve insulin sensitivity and ovulation rates, particularly in people with PCOS. Vitamin D is also key for reproductive health, as well as omega-3 fatty acids, which can help reduce inflammation and improve metabolic function.
Medical treatments
For some individuals, assisted reproductive technologies like IVF may be necessary. However, addressing insulin resistance before and during fertility treatments can improve success rates and reduce the risk of complications. There are multiple ways your care provider may approach this.
Metformin
Medical treatments for insulin resistance often include metformin, a medication that improves insulin sensitivity and can help restore ovulation in people with PCOS. Research shows that metformin, when used to treat PCOS:
- Reduces serum androgen levels
- Improves insulin sensitivity
- Successfully triggers ovulation
- Restores menstrual cyclicity
- Improves pregnancy and live-birth rates
GLP-1 Receptor Agonists
Newer medications called GLP-1 receptor agonists (more commonly known under brand names like Ozempic or Wegovy) can help with both weight management and insulin sensitivity while preparing for pregnancy. More research on using GLP-1s in fertility contexts is needed however, as there is not enough scientific evidence to confirm they are safe to take during pregnancy.
For comprehensive fertility support, including treatment for insulin resistance-related fertility challenges, Carrot Sprints offers a clinically-backed program designed to address fertility obstacles caused by obesity, blood sugar dysregulation, and other metabolic disorders. The program includes pre-pregnancy habit-building with daily coaching for nutrition, movement, sleep, and stress management, along with access to clinically managed medications when appropriate for obesity-related fertility challenges.
Prevention and long-term management
Preventing insulin resistance or managing it effectively requires long-term lifestyle strategies that support metabolic health and reproductive function. The earlier you address risk factors, the better your chances of maintaining healthy insulin sensitivity and fertility.
Some of the most important things to focus on to support fertility include:
- Maintain a healthy weight. Balanced nutrition and regular exercise can significantly reduce your risk of developing insulin resistance. Even modest weight loss of 2-5% can lead to meaningful improvements in insulin sensitivity and fertility.
- Manage stress. Chronic stress can elevate cortisol levels and worsen insulin function. Techniques such as meditation, yoga, and regular relaxation can help maintain healthy stress levels.
- Prioritize sleep quality. Sleep deprivation can impair insulin sensitivity and disrupt reproductive hormones. Aim for 7-9 hours of quality sleep per night and maintain consistent sleep schedules.
- Get regular health checks. Annual check-ups should include screening for insulin resistance, especially if you have risk factors or are planning to get pregnant.
Frequently asked questions
Is insulin resistance reversible?
Yes, insulin resistance is often reversible, especially when caught early. Through consistent lifestyle changes including regular exercise, healthy eating, weight management, and sometimes medication, many people can significantly improve their insulin sensitivity. The key is maintaining these changes long-term, as insulin resistance can return if healthy habits are abandoned.
Can you do IVF with insulin resistance?
Absolutely. Many people with insulin resistance successfully undergo IVF treatment. However, addressing insulin resistance before starting IVF can improve success rates and reduce the risk of complications during pregnancy. Your fertility specialist may recommend optimizing your metabolic health through lifestyle changes or medications like metformin before beginning treatment.
Does insulin resistance impact egg quality?
Research suggests that insulin resistance can negatively affect egg quality through increased inflammation and oxidative stress in the ovaries. High insulin levels may also disrupt the ovarian environment where eggs mature. Improving insulin sensitivity through treatment can help optimize egg quality and overall reproductive outcomes.
Can people with insulin resistance have healthy pregnancies?
Yes, with proper management, people with insulin resistance can have healthy pregnancies and babies. The key is optimizing metabolic health before getting pregnant and maintaining good glucose control throughout pregnancy. This may involve lifestyle modifications, medications, and close monitoring by healthcare providers to prevent complications like gestational diabetes.
What are early warning signs of fertility problems caused by insulin resistance?
Early signs may include irregular menstrual cycles, difficulty losing weight, skin changes like dark patches (acanthosis nigricans), increased hunger or cravings, fatigue, and taking longer than expected to conceive. For men, symptoms might include decreased libido or erectile dysfunction. If you notice these signs, consider discussing insulin resistance screening with your healthcare provider.
The relationship between insulin resistance and fertility is complex, and involves hormonal disruptions, inflammation, and changes in egg and sperm quality. However, effective options exist for managing insulin resistance-related fertility challenges through lifestyle modifications, medical treatments, or assisted reproductive technologies. Addressing this condition can significantly improve your chances of conceiving and maintaining a healthy pregnancy.
If you suspect insulin resistance may be affecting your fertility, consider speaking with a fertility specialist or endocrinologist who can provide comprehensive evaluation and personalized treatment recommendations. Taking action to address insulin resistance is an investment in both your immediate fertility goals and your long-term health.
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