High Insulin Levels and Infertility

The majority of failed IVF cycles – and undoubtedly also failed attempts at natural conception or other types of assisted reproduction – are related to abnormal embryos.

And one undisputed contributing factor to the development of abnormal embryos is a increasingly common autoimmune disease: hyperinsulinemia. It affects both the female partner and the quality of her eggs, and the male partner and the quality of his sperm. In addition, it negatively affects the uterine environment, making successful implantation of the embryo less likely.

In this article, Dr Antonio Rodrigues, a reproductive medicine specialist and a founder and director of Medfem Fertility Clinic in Sandton, Johannesburg, South Africa, explains the link between high insulin levels and infertility and shares treatment options that can effectively address the problem.

Read more about high insulin levels and its impact on IVF success below, or click here to watch the full hour-long webinar on myivfanswers.com.

Normal embryos are essential for fertility

An embryo is an egg cell that has been fertilised by a sperm cell.

Healthy embryos are only possible with healthy eggs and healthy sperm. In medical terms, healthy embryos are also known as ‘chromosomally normal’ or ‘euploid embryos’.

Studies have shown that as many as 50% of fertilised eggs or embryos are chromosomally abnormal. These chromosomally abnormal embryos are likely to fail to implant in the uterus or may result in a miscarriage, whether during natural conception or if transferred into the uterus during IVF or another assisted reproductive treatment.

So how does one get chromosomally normal embryos that will provide much better pregnancy rates?

What is required is a health egg and a healthy sperm. Unfortunately, for people who have high levels of insulin, the result is increased number chromosomally abnormal, poor-quality eggs and an increased number of chromosomally abnormal, poor-quality sperm.

What is insulin and what does it do?

The food we eat is converted into glucose that is released into the bloodstream to be carried to the cells of the body. Insulin is a hormone that unlocks the cells of the body so they can absorb the glucose energy from the blood.

As a result, normal insulin levels are lower in the morning when you wake up. This is called a ‘fasting’ insulin level, and we regard a level of anything above nine as abnormal.

After eating breakfast, the insulin level rises to process the sugar or carbohydrates consumed at breakfast and to bring the glucose levels in the blood back to normal, after which the insulin levels should drop again.

Increasing numbers of people, however, are now suffering from high insulin levels or hyperinsulinemia, an autoimmune disease.

While it is generally associated with problems with excess weight, hyperinsulinemia also affect people who are underweight, and it affects both men and women.

Just some of the effects suffered by those who have high insulin levels is tiredness, moodiness or irritability, food cravings and post-eating dips in their energy levels, especially in the afternoons and evenings. Less well-known is the effect of high insulin levels on sperm and the eggs.

The effect of high insulin levels on sperm

More than 15 years ago, our team at Medfem Fertility Clinic realised that poor embryos were not the result of poor egg quality only, but also a result of the quality of the sperm – which was substantially adversely affected by high insulin levels.

When high insulin levels in male partners were treated effectively, the quality of the embryos improved, and the pregnancy rates went up.

We’ve done a lot of research on this condition – called male hyperinsulinism – in our clinic over the last 10 years. We can confirm that high insulin levels adversely affect the quality of the sperm – and poor-quality, abnormal sperm will create an abnormal poor-quality embryo.

The effect of high insulin levels on eggs and the uterus

The effects of high insulin levels on egg quality among women has been well-recognized for decades.

The little eggs developing in follicles in the ovary do not respond well to an up-and-down supply of sugar – they need a constant flow of glucose energy to develop normally.

In addition, the dominant follicle, the one that contains the egg that will become the dominant egg, finds it difficult to suppress all the other eggs that were recruited as possibilities during the early phase of the ovulation cycle. The fluctuation of the energy to the prevents the follicle from growing beyond 14 millimetres – and even if it does, sometimes it grows very slowly and becomes abnormal with time.

Another consequence of high insulin levels is that the uterine lining is often thin, not the thick nutrient-rich uterine lining that is critical for successful implantation of a healthy embryo. The receptors for estrogen and progesterone also work better when the cells in the in the uterus have the right amount of steady energy.

High insulin levels also play a big role in polycystic ovarian syndrome, another common cause of infertility in women.

Treatments for hyperinsulinemia

So, it is well-established that high insulin levels lead to an increased incidence of abnormal eggs and sperm, as well as an unfriendly uterine environment. That, of course, will in turn lead to an increased incidence of chromosomally abnormal embryos and failed implantations, and that ultimately results in the inability to conceive naturally, recurrent IVF failures, and a higher incidence of miscarriages.

Treatment for high insulin levels

The good news is that high insulin levels are easy to diagnose with a simple blood test – and it can also be managed easily and effectively.

One of the main causes of hyperinsulinemia is high carbohydrate diets. Carbohydrates raise insulin levels, and it causes weight gain in some people, as well as tiredness and high cholesterol.

Whether you are trying to conceive or not, any carbohydrates in your diet must be in moderation. Ideally, you want to avoid refined carbohydrates and only eat carbohydrates that have low glycemic index as part of a balanced eating plan. That will generally do the trick.

However, if you cannot lose weight or if you’re really struggling with poor eggs or poor sperm, the Banting diet or the high-protein diet with no carbohydrates has been beneficial for certain people, and works very well for men who are overweight.

If you as a couple are eating properly, the quality of both the egg and the sperm will be improved, and that will result in a better-quality embryo. In addition, the uterus will be more receptive because the endometrial linings are healthy.

Medical treatments for high insulin levels

While diet will always play the main role in managing high insulin levels, there are also medications that are used very effectively at Medfem Fertility Clinic.

Metformin is the treatment of choice and is generally also prescribed for polycystic ovaries. We prescribe the long-acting Glucophage that is taken once a day because the quick-acting Metformin must be taken many times a day and has side effects. The doses are increased until normal insulin levels are achieved. Another natural product called Inositol is also used.

In IVF patients there is a definite positive benefit from these medications: improved egg quality, and therefore improved embryos that are chromosomally normal and result in higher pregnancy rates and higher life birth rates.

If you would like to know more about hyperinsulinemia and its effect on your fertility, or if you are concerned that high insulin levels are affecting or could affect the success of your IVF treatment, we would be happy to answer your questions.

To meet one of our fertility specialists at Medfem Fertility Clinic, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

We look forward to meeting you!

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