How Diabetes Affects Fertility and Pregnancy

If you or your partner has diabetes and you are thinking about starting a family, you may be wondering whether it will make things harder. It is a fair question, and the honest answer is reassuring: many people with diabetes conceive and have healthy babies. What matters most is how well your blood sugar is managed before and during pregnancy.

More than 500 million adults worldwide live with diabetes, yet its link to fertility is rarely discussed. This guide explains how diabetes can affect fertility in women and men, what it means for pregnancy, and how to prepare so you give yourself the best possible start.

How Does Diabetes Affect Fertility?

Diabetes is a condition in which your body cannot use glucose (sugar) properly, either because it does not make enough insulin or because it does not respond to insulin well. There are three main types:

Type 1 diabetes. An autoimmune condition in which the body stops making insulin. It accounts for roughly 5 to 10 percent of cases.
Type 2 diabetes. The most common type, making up about 90 percent of cases. It is closely linked to insulin resistance.
Gestational diabetes. Diabetes that develops during pregnancy, usually in the second or third trimester.

Here is the key point: well managed diabetes does not necessarily reduce fertility. When blood sugar stays high for long periods, however, it can disrupt the hormones that control ovulation and sperm production, and it can affect the health of a pregnancy once it begins. The good news is that this is largely something you can influence.

Does Diabetes Affect Female Fertility?

It can, and the effect depends on the type of diabetes and how well it is managed.

Type 2 diabetes and insulin resistance. High insulin levels can push the ovaries to produce more androgens, which can interfere with ovulation. This is one reason type 2 diabetes and polycystic ovary syndrome (PCOS) often overlap. PCOS raises the risk of developing type 2 diabetes, and insulin resistance is a core feature of both. If you have PCOS, our guide on PCOS and fertility: can you still get pregnant and our post on how long it takes to get pregnant with PCOS will help you understand your timeline.

Type 1 diabetes. Some studies suggest women with type 1 diabetes may have a later first period, more irregular cycles, and an earlier menopause. With modern care and good glucose control, fertility is often similar to that of women without diabetes.

Irregular cycles. If your periods are unpredictable, you may be ovulating less often. Learning the signs of ovulation can help you time intercourse and spot problems early.

Weight and metabolic health. Extra weight, especially around the middle, can worsen insulin resistance and ovulation problems. Even a modest improvement in blood sugar and weight can help restore regular cycles for some women.

Does Diabetes Affect Male Fertility?

Yes. Men with diabetes are often overlooked in fertility conversations, but diabetes can affect male reproductive health in several ways:

Lower testosterone. Low testosterone is more common in men with type 2 diabetes, and it can reduce sex drive and sperm production.
Erectile dysfunction. High blood sugar can damage nerves and blood vessels, and erectile dysfunction affects up to about half of men with diabetes.
Ejaculation problems. Nerve damage can cause retrograde ejaculation, where semen flows backward into the bladder instead of out of the body.
Sperm quality. Poorly controlled diabetes is linked with lower sperm motility and more DNA damage in sperm.

As with women, improving blood sugar control, weight, sleep, and activity can improve these problems for many men. If you want to understand testing and treatment options, read our guide to male infertility causes, tests, and treatment.

How Does Diabetes Affect Pregnancy?

Pregnancy places extra demands on your body, and diabetes adds another layer to manage. The biggest concern is high blood sugar, especially in the early weeks, because that is when your baby’s organs are forming, often before many people know they are pregnant.

When blood sugar runs high before and during early pregnancy, the risks can include:

Miscarriage
Birth defects, including heart and neural tube conditions (the risk rises as A1C rises)
Preeclampsia and high blood pressure
A larger than average baby, which can lead to a more difficult delivery or a cesarean birth
Preterm birth
Low blood sugar in the newborn after delivery
Stillbirth, which is uncommon but more likely when diabetes is poorly controlled

Please read this part carefully: these are risks, not certainties. Most women with diabetes who plan carefully and work with a medical team have healthy pregnancies. If miscarriage is on your mind, our guide to common miscarriage myths and facts can help you separate fear from fact.

Your body will also change during pregnancy. Insulin needs often drop slightly in the first trimester, then rise as pregnancy progresses and insulin resistance increases. That is why frequent monitoring and adjusting your plan matters.

What Is Gestational Diabetes?

Gestational diabetes develops during pregnancy in about 2 to 10 percent of pregnancies, when pregnancy hormones make your body more resistant to insulin. It is usually screened for between 24 and 28 weeks, and earlier if you have risk factors.

Most women manage it with nutrition changes and physical activity, and some need medication or insulin. It usually goes away after delivery, but it matters for your long term health: having gestational diabetes raises your risk of type 2 diabetes later, so ongoing screening every one to three years is recommended.

How Can You Prepare for Pregnancy With Diabetes?

Planning ahead is one of the most powerful things you can do. Many unplanned pregnancies catch people before blood sugar is where it needs to be, so preparing early gives you an advantage. Here is what to focus on.

Aim for a healthy A1C before you conceive. A1C reflects your average blood sugar over the past two to three months. As a general guide, guidelines from groups such as the American Diabetes Association and the UK National Health Service recommend aiming for an A1C below about 6.5 percent before pregnancy, as long as you can reach it safely without frequent low blood sugar. Your provider may set a slightly different target for you.

Give yourself time. Because A1C reflects about three months, many people plan for three to six months of preparation. Our guide on how long it takes to improve fertility naturally shows how that timing works.

Have a preconception checkup. Ask your healthcare team to review your eyes, kidneys, blood pressure, and thyroid. A dilated eye exam is recommended before pregnancy because pregnancy can speed up changes in the retina.

Review your medications. Some medications used for diabetes, blood pressure, and cholesterol are not recommended in pregnancy. These can include certain GLP 1 medicines, which may need to be stopped well in advance (in some cases at least two months before conception), as well as statins, ACE inhibitors, and ARBs. Never stop or change a medication on your own. Your provider can help you switch safely.

Take the right folic acid dose. The standard recommendation is at least 400 micrograms daily before conception. Some guidelines, including those in the UK, advise a higher dose of 5 milligrams for women with diabetes, so ask your provider which dose is right for you. For other supplements, see our guide to the best fertility supplements.

Monitor closely. Continuous glucose monitoring can be very helpful, particularly with type 1 diabetes. During pregnancy, common targets are a fasting level below 95 mg/dL, below 140 mg/dL one hour after meals, and below 120 mg/dL two hours after meals. For people with type 1 diabetes using a continuous monitor, a common goal is to spend more than 70 percent of the day between 63 and 140 mg/dL.

Eat for stable blood sugar and fertility. Build meals around protein, fiber, healthy fats, and slow digesting carbohydrates. Our fertility nutrition guide walks you through it.

Move in a way that supports your body. Regular walking and strength training improve insulin sensitivity. Very intense, frequent workouts can add stress, so more is not always better. You can read more in why Katy stopped doing high intensity workouts.

Review your habits. Smoking, heavy alcohol use, and poor sleep all work against blood sugar and fertility. See what to avoid when trying to conceive for a full list.

Use reliable contraception until you are ready. If your blood sugar is not yet where you want it, effective birth control protects you while you prepare.

Can You Do Fertility Treatment With Diabetes?

Yes. If you have been trying without success, fertility treatment is an option. Depending on your situation, that may include ovulation induction medications, intrauterine insemination (IUI), or in vitro fertilization (IVF), with or without ICSI.

Studies suggest that when blood sugar is well controlled, outcomes are similar to those of people without diabetes. The key is to keep glucose steady throughout treatment, because hormone medications and stress can affect your levels. Let your fertility team know about your diabetes from the start so your care is coordinated with your diabetes provider.

When Should You See a Provider?

With diabetes, it makes sense to plan rather than wait. Talk to your healthcare team before you start trying, and seek fertility guidance earlier if:

Your periods are irregular or absent
You have PCOS or signs of insulin resistance
You have been trying for 12 months, or 6 months if you are 35 or older
Your partner has erectile dysfunction, ejaculation problems, or low testosterone
You have had a previous pregnancy loss

Our guides on when to get fertility testing and being not pregnant after 6 months can help you decide when it is time to take the next step.

Frequently Asked Questions About Diabetes and Fertility

Can you get pregnant if you have diabetes?

Yes. Many women with type 1, type 2, or gestational diabetes have healthy pregnancies. Planning ahead and keeping blood sugar in a healthy range gives you the best chance.

Does diabetes cause infertility?

Diabetes does not automatically cause infertility. Poorly controlled diabetes, and conditions linked with it such as PCOS and obesity, can make conception harder. Well managed diabetes often has little effect on fertility.

What A1C is safe for getting pregnant?

Many guidelines suggest aiming for an A1C below about 6.5 percent before conception if it can be done safely. Your provider will tailor this to you, and the lower your A1C is when you conceive, the lower the risk of complications.

Can diabetes cause a miscarriage?

High blood sugar around conception and in early pregnancy is associated with a higher chance of miscarriage. Keeping glucose well managed before you conceive lowers that risk.

Can men with diabetes have fertility problems?

Yes. Diabetes can lower testosterone, cause erectile dysfunction and ejaculation problems, and affect sperm quality. These issues are often improved with better blood sugar control and medical support.

Will I have diabetes forever if I had gestational diabetes?

Most women return to normal blood sugar after delivery, but gestational diabetes raises the risk of developing type 2 diabetes later. Regular screening and healthy lifestyle habits lower that risk.

Can I take diabetes medication while trying to conceive?

Some medications are safe to continue, while others should be changed before pregnancy. Do not stop or switch medication on your own. Talk to your provider before you start trying.

Take the Next Step

Diabetes does not close the door on parenthood. With planning, steady blood sugar, and a supportive care team, many people go on to have healthy pregnancies and healthy babies.

If you want personalized guidance on preparing your body for pregnancy, Katy Poole, a fertility consultant and nurse practitioner, offers one on one fertility consulting services to help you understand your labs, cycle, and next steps. You can also explore the Get Pregnant Faster program or browse more fertility health resources.