Gynaecologist and IVF Specialist Dr. Sagarika Aggarwal: “Diabetes is an undefined cause of infertility”
Even in the emerging scenario of making a choice of no kids, a term popularly coined as Double Income No Kids (DINKS) group of people, there is still a dark truth hidden behind the four walls. There are many more marital alliances which suffer from the childless syndrome, which can be medically attributed to a list of different unidentified reasons. While we definitely don’t propagate this decision in either ways, considering it’s a personal matter between couples, however, we are not even surprised about the fact of mental trauma associated with infertility in India. They may not be making noise in the society, but this mental condition of a couple can only get worsened with the time, says Dr. Sagarika Aggarwal, Gynaecologist and IVF Specialist Indira IVF Hospital Delhi. In a free-wheeling chat with The Indian.News Editor, Jayashankar Menon, Dr. Sagarika speaks in length about diabetes and its complications that can impact a healthy lifestyle. Excerpts:
TIN: How does this mental condition of a couple could get worsened with the time?
SA: Even in the emerging scenario of making a choice of no kids, a term popularly coined as Double Income No Kids (DINKS) group of people, there is still a dark truth hidden behind the four walls. There are many more marital alliances which suffer from the childless syndrome, which can be medically attributed to a list of different unidentified reasons. While we definitely don’t propagate this decision in either ways, considering it’s a personal matter between couples, however, we are not even surprised about the fact of mental trauma associated with infertility in India. They may not be making noise in the society, but this mental condition of a couple can only get worsened with the time.
TNI: What are the psychological factors associated with the undue attention?
SA: There are many psychological factors associated with the undue attention, which a non-conceiving health condition warrants, eventually. Health experts continue to cite a loss of sense of personal stability to having no hope for the future kind of sinking feeling every time. Chances of developing a low self-esteem leading to depression only increase with the time. In a more societal context, the inability to carry forward your family genetics or legacy can weigh heavy on the couple’s mind. As a result, even a strong foundation base of a marital cord can be shaken, based on the social taboo.
TIN: How does the quality healthcare help save women bearing the brunt of not giving birth?
SA: Medically speaking, more often than not, the women have to bear the brunt of not giving birth. Today, quality healthcare service is much more accessible, and people are more aware of their problems. Clinically detecting the exact reason doesn’t present much of a challenge. However, there are still many complications which remain unfolded medically. Such as male infertility due to diabetes can also be a chief reason for complicating the situation.
TNI: If a woman suffers from diabetes, can there be major health concerns for both mother and the baby?
SA: If a woman is suffering from diabetes, there can be major health concerns for both mother and the baby. Just to give a broader outline for the consequences, an increased level of glucose in the blood increase the risk of embryo being implanted in the uterus, thus leading to miscarriages. A c-section becomes a must as the baby is born larger than the normal size, with other health deformities likely to be attached after giving the birth. It can be a serious concern for the mother too, leading to infection for both mother and the baby. We feel it’s important to delve a bit more on the topic, so as to help couples make a wise decision with right amount of information.
TIN: Can you elaborate on the types of Diabetes and how to control it?
SA: Diabetes can be categorised in to Type 1 and Type 2. While both the conditions will reduce the level of insulin in the body, requiring you to take injections to produce the correct biological sugar levels through prescribed insulin injections. Type 1 diabetes, as clinically defined, destroys the insulin producing cells in the body, which can only be supplemented by injections. It is a highly unsafe situation for pregnancy as the body needs to have a minimum level of insulin to conceive. As a result, it is perceived to be more unfavourable for both mother and the child.
Type 2 diabetes is a result of the body’s inability to keep up with the required glucose levels in the bloodstream, thus, not producing enough insulin in the body. However, it can be controlled with making dietary changes and an increase in exercise. While type II diabetes can be controlled, since it is a result of controllable factors, with an effort to reduce your weight and make some lifestyle changes, type 2 diabetes is a genetic factor. Type 1 diabetes is common amongst the youngsters, and the condition can only worsen with time. The exact cause is unknown, even clinically suspicious of a virus responsible for the growth of the disease.
Take this medical fact for consideration. In both cases, insulin is a hormone which in case of diabetes makes your body resistance to this hormone; thus causing a biological imbalance. One hormone imbalance can have a profound effect on the functioning of other jointly functional hormones including oestrogen, progesterone and testosterone levels. As a result, ovarian cysts to erectile dysfunction and infertility, is not a totally unfounded condition in diabetics.
TIN: What are the causes of infertility in women?
SA: In case of obese women, the risk associated with type 2 diabetes is higher as the factor of insulin resistance is even greater. Polycystic Ovarian Syndrome (PCOS) and Dysmetabolic Syndrome X are two serious medical causes for a high degree of infertility in women. PCOS has been identified as a proven condition for female infertility; while PCOS is also found to be high in women suffering from insulin resistance, especially an obese woman. Both the factors are clinically associated with obesity and, as a result diabetes too.
Another serious infertility condition is associated with the type 1 diabetes, in which your natural metabolism or insulin cells are destroyed in the body. Such a patient suffers from high glucose levels, which leads to the embryo not being implanted in the uterus. The chances of miscarriage are very high in such cases, with the woman having to deal with the failure of chances of getting pregnant, again and again.
TIN: How about the infertility in men?
SA: The cause of neuropathy or nerve damage can lead to serious infertility consequences for men. Erectile difficulties, which can be directly correlated with the nerve damage from diabetes, can be a major cause for infertility in men. High levels of blood glucose, blood pressure and cholesterol, all clubbed together only aggravate the problem of getting a proper erection in men. The problem of nerve damage can also be extended to retarded ejaculation, when nerves in the penis get damaged. The nerve damage from diabetes can also lead to a condition where the nerves are unable to control the bladder, and as a consequence, instead from closing at the point of ejaculation, the semen entering exits via the penis.
In a more genetically defined context, type 1 diabetes in men can lead to DNA damage in their sperm, thus seriously hampering the chances of impregnating the partner, or reducing the chances of live birth and even healthy, normal fetus.
TIN: As the saying goes, “Prevention is better than Cure”, what would you suggest the prevention from infertility?
SA: it is important to understand your medical condition for giving birth, for both men and women; the high risk of infertility can be better managed by being more aware of the risks of a high insulin resistance in your body. Type 2 diabetics can clearly try and get their weight up to an optimum level required for pregnancy. The researchers in this field have proved that type 2 diabetes women suffering from obesity are at a higher risk on not conceiving as compared to a non obese woman. Type 2 diabetes is only controllable, if you can reduce the risk of being overweight which leads to an increased glucose level in your body.
A wise decision is to get A1C levels below 6.5 before attempting to get pregnant, and controlling your daily sugar intake before planning a pregnancy, and having a healthy baby. Fitness coupled with lifestyle changes can reduce the risk on this modern disease prevailing across the world. Reducing the dependence on alcohol and quitting smoking are some of the factors to reduce Erectile Dysfunction. Retarded ejaculation is also associated with certain psychological problems. It is advisable to seek proper clinical counselling, or psycho-sexual therapy to reduce this burden.