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Metabolic-Health@outlook.com
Oct 31, 20225 min read

Insulin Resistance and Infertility

Updated: Apr 28, 2023

Infertility & insulin resistance

Dr Richard Mackenzie & Dr Giada Fron

tino

13 October 2022



The rise in obesity globally is contributing to a number of health conditions including cancer, cardiovascular disease, type 2 diabetes and infertility. Linked to diabetes, there is another health concern that has ties with obesity that is largely hidden from us - insulin resistance. Insulin resistance is becoming one of the biggest obstacles to getting pregnant. Insulin resistance, a potential consequence of obesity, occurs when muscle, fat, and liver cells do not respond efficiently to insulin, making it more difficult for the cells to absorb glucose from the bloodstream. That in turn leads to higher blood glucose levels and an even higher production of insulin. The net result is a decrease in the breakdown of stubborn fat stores.



This silent condition is indeed the starting point of many health issues such as diabetes, cardiovascular disease and cancer. Although insulin is a key hormone that allows the body to store glucose, in states of insulin resistance, increased insulin secretion, and so blood insulin (hyperinsulinaemia) can be a bad thing1. For example, elevated insulin in the blood communicates with fats cells inhibiting the breakdown of fat (lipolysis) and thus contributes to obesity2! This could be the very reason it hard to shift that stubborn hip fat. Indeed, a study found that moderately elevated insulin slowed down fat breakdown by 75%2 while increase blood insulin levels injections increased the occurrence of cancer3.


The National Institute for Clinical Excellence (NICE, 2014) estimated that one in seven couples in the UK are affected by infertility4. More recently, a publication by the Office for National Statistics (2019) confirmed that the birth rate in England and Wales had reached a new low during 20185. One suggested link between the increased rates of infertility and obesity is the increase in insulin resistance that accompanies both conditions6. Indeed, insulin resistance and hyperinsulinemia-induced obesity have adverse effects on our reproductive system, which seem to be worsened in women with polycystic ovary syndrome (PCOS)6. Let's also be clear, insulin resistance can also be present in those of a healthy weight and under conditions of stress.


Elevated insulin in the blood induces early response to luteinizing hormones on granulosa cells of small follicles, which can prevent eggs being released during menstruation. Put more simply, insulin resistance could be stopping you from ovulating and making it harder for you to get pregnant. Insulin resistance can lead to irregular ovulation, a key contributor in infertility. Key warning signs of irregular ovulation include a lack of periods and/or having intermittent period length and duration between periods.





Stress and Insulin Resistance

If you are suffering from irregular periods, the important message is try not to stress about it. A key hormone in the stress response is cortisol. Under stressful conditions, cortisol is released and stimulates fat and carbohydrate stores to release energy, releasing excess energy into the body. This process also promotes appetite driving us to eat more sugar and fatty foods. In addition to this, insulin and cortisol seem to work together, causing fat production from other energy sources7. All of which would contribute to the difficulty in shifting that stubborn fat around the body. Indeed, high cortisol, chronic stress and insulin resistance predicted short-term weight gain over a 6-month period8.


In addition to this, the increase in blood sugar would further increase insulin resistance and elevate blood insulin, both of which would further reduce fat loss and cause infertility problems.




How to treat insulin resistance and elevated insulin in the blood?

In some circumstances, improving insulin resistance can bring back ovulation and improve fertility9. Other times, a combination of approaches that target both insulin resistance and fertility are required to improve the chances of pregnancy.


1. The first step is to get more physical active. One bout of exercise (walking, jogging, swimming or cycling) can improve insulin resistance for up to 72 hours. So, get moving. The suggest daily exercise recommendations is 30 minutes per day. Please be aware that if you are stress with work and life, HIIT exercise may be adding to your insulin resistance via stress. Please contact us for more information.

2. Limit sugary foods and drinks and processed / junk food. Eat less often and engage in some form of fasting from food although. Fasting is a potent approach to improve insulin resistance. Aim to reduce your body weight by 5-10%. It would also be worth having your insulin resistance checked by a clinic.

3. Avoid lifestyle choices that cause you stress. Improve your mental health and take on meditation and yoga.

4. Medication – Medications like Metformin are often prescribed to Type 2 diabetics and PCOS patients to help control blood sugar.

5. Fertility treatments : Insulin-sensitising agents such as metformin improve ovulation and pregnancy outcomes. However, lifestyle changes are essential in addition to treatment with insulin‐sensitizing


agents in order for these to be effective. Inositol is a substance that is naturally present in our cells and in some foods and regulates insulin, Follicle-Stimulating Hormone (FSH) and other hormones—taking inositol supplements shows positive effects comparable to metformin on insulin sensitivity, egg quality and pregnancy rates. Exercise and a healthy diet are also known to significantly improve insulin-resistance and reproductive outcomes.



Please contact us to book a consultation to discuss which options are best for you.



Reference

1. Kolb, H., Kempf, K., Röhling, M. et al. Insulin: too much of a good thing is bad. BMC Med 2020 ;18(224). https://doi.org/10.1186/s12916-020-01688-6.

2. Jacob S, Hauer B, Becker R, Artzner S, Grauer P, Loblein K, et al. Lipolysis in skeletal muscle is rapidly regulated by low physiological doses of insulin. Diabetologia. 1999; 42(1171–4). DOI: 10.1007/s001250051288

3. Holden S, Jenkins-Jones S, Morgan C, Schernthaner G, Currie C. Glucose-lowering with exogenous insulin monotherapy in type 2 diabetes: dose association with all-cause mortality, cardiovascular events and cancer. 2015; 17(4). DOI: 10.1111/dom.12412

4. NATIONAL INS


TITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) Report. Fertility Problems Briefing Paper. 2014. chromeextension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.nice.org.uk/guidance/qs73/documents/fertility-problems-briefing-paper2

6. Gambineri A, Laudisio D, Marocco C, Radellini S, Colao A, Savastano S; Obesity Programs of n



utrition, Education, Research and Assessment (OPERA) group. Female infertility: which role for obesity? Int J Obes Suppl. 2019 (1):65-72. doi: 10.1038/s41367-019-0009-1.

7. Björntorp P. Hormonal control of regional fat distribution. Hum Reprod. 1997 Suppl 1:21-5. doi: 10.1093/humrep/12.suppl_1.21. PMID: 9403318

8. Chao AM, Jastreboff AM, White MA, Grilo CM, Sinha R. Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity (Silver Spring). 2017 (4):713-720. doi: 10.1002/oby.21790.

9. Liu Yuqi, Li Juan, Yan Zhe, Liu Dan, Ma Jinfang, Tong Nanwei. Improvement of Insulin Sensitivity Increases Pregnancy Rate in Infertile PCOS Women: A Systemic Review Frontiers in Endocrinology. 2021 Vol 12 DOI=10.3389/fendo.2021.657889.















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