Diabetes and IVF

One of the reasons I gave for sharing our IVF journey was to do a small bit towards addressing the paucity of information about handling type 1 diabetes alongside fertility treatment. Of course, I then got wrapped up in the actual trying to get pregnant stuff, and so far have mentioned very little about the diabetes side of things.

Before I started IVF, however, I was somewhat frustrated by the lack of information about doing it alongside diabetes. There are a handful of threads of a variety of fertility forums, and a similar number on a range of diabetes forums, but just a few personal experiences recounted on blogs and very little credible scientific or medical literature.

That is not to say there is nothing of use, just not all that much and it would be remiss of me not to share a couple of helpful resources. One of the first sites I turned to is a blog written by Cheryl Alkon which is sadly no longer updated. Cheryl underwent fertility treatment back in 2006 and blogged her way through it, sharing a number of useful insights. She then went on to write the successful book “Balancing Pregnancy with Pre-existing Diabetes” (which I reviewed here). The book itself also contains chapters on fertility treatment. (Some of the information contained in the book may not be strictly relevant for readers outside the US, but it is an excellent starting point.)ย And another useful resource and personal account of the IVF process can be found on The Kaitake Blog, written by a New Zealand woman, who is happily currently about half way through her pregnancy.

I wondered, though, whether the fact that I couldn’t find more was because the combination of IVF and diabetes is not that common. But looking back now, having actually done it myself, I think it may be more likely that it isn’t talked about much simply because there isn’t that much to say that isn’t standard diabetes advice about frequent testing and adjustments.

And my own quietness on the subject is almost certainly a reflection of there not being that much to mention. I can honestly say that diabetes has not had a major impact on IVF, and whilst IVF has obviously affected my blood sugars to a degree, it has not been horrifyingly unmanageable. After all, if you live with diabetes, you have to be used to a bit of unpredictability!

If you ask people who, by their own admission, know very little about the process of IVF to share what they do know, many of them seem to mention the “induced menopause”. In proper IVF-speak this is known as “down regulation” – the process of shutting off the bodies own hormonal cycle, before starting to stimulate the ovaries to produce lots of eggs. However, this isn’t an inevitable part of the treatment, and not everyone undergoing IVF goes through the down regulation process, otherwise known as the “Long Protocol” (LP).

I was on the alternative option – the “Short Protocol” (SP)ย in which stimulation of the ovaries begins on around day 2 or 3 of the cycle, alongside drugs to prevent ovulation. As the name suggests, this a quicker treatment cycle, injecting for around 8-14 days in total,compared to 3+ weeks.

This has distinct advantages for people with diabetes. Firstly it is a less dramatic suppression and replacement of your own hormones, so my guess is that it has slightly less dramatic effects on blood sugar levels. And secondly, the shorter duration means fewer days overall of taking drugs with the potential to affect control.

As it worked out for me, I spent a month taking the contraceptive pill before commencing the active part of the treatment. This is common as it allows clinics to time your cycle, as well as reducing the risk of cysts (ha – that obviously didn’t work for me!) or the uterine lining not being thin enough. I’ve taken the pill before, albeit a long time ago, so I had some idea what to expect. Typically taking external oestrogens raises my requirements for insulin by around 25%. So I raised my basal rates around the clock and kept a close eye on the CGM. Which worked out well.

I then had a break of about six days between stopping the pill and starting to inject Burserelin, the medication which prevents ovulation. In my previous hormone-using days, I had a different profile set up in my pump for the hormone free week. However the week off medication was a stressful one, with discovering a cyst of my ovary and having it drained. I realised afterwards that I had maintained the increased basal rate with only a modest increase in hypoglycaemia during that time. And when I started Burserelin, everything fell back into place.

The leaflet included with Burserelin specifically mentions that it may cause raised blood sugars in people with diabetes. And based on my experience, I’d say that effect is equivalent to the effect of oestrogen. Your diabetes may, of course vary, as it is a completely different hormone. My best advice is to test, test, test.

The stimulation drugs – I was on Menopur – by contrast, had very little noticeable effect on things. I had a number of stubborn and sticky highs, but an equal number of troublesome lows. Overall, I’d say my blood sugars seemed a bit more volatile – swinging more from high to low – than has been normal for me of late. But stress and anxiety during fertility treatment have a lot to answer for too, and obviously it becomes impossible to tell for sure what is affecting what.

The bottom line, however, is that IVF with diabetes is totally do-able. Compared to the changes you will experience in pregnancy (which is the intended outcome, after all) it really is a walk in the park. As with everything diabetes, frequent testing helps. A CGM helps even more. And a pump provides the flexibility to react day-to-day and hour-to-hour much more than multiple daily injections.

I’ll definitely do it again if we have to. And diabetes would be a very long way down any list of reasons not to.

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2 Replies to “Diabetes and IVF”

  1. Hi! Just popped over to say thank you for mentioning me in your post, and I agree wholly with what you say. Information about type 1 diabetes and IVF is very thin on the ground indeed. I’m glad to see a few more people are blogging there experiences as it helps others. And it’s totally doable ๐Ÿ™‚ Good luck and best wishes ๐Ÿ™‚

    1. No problem. I’ve found your blog quite useful because I like reading personal accounts, and you write with such a genuine voice. I hope the rest of your pregnancy goes smoothly! ๐Ÿ™‚

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