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Challenge: Patients with diabetes requiring ART.

Background:

 More and more couples with diabetes are seeking ART due to the global rise in the prevalence of diabetes mellitus and impaired glucose intolerance.

 Diabetes affects male and female gametes.

 In men, type 2 diabetes is associated with hypogonadism and erectile dysfunction.

 Uncontrolled diabetes in pregnancy is not only teratogenic during the period of organogenesis with increased risk of miscarriage but also programs the offspring’s future risk of cardiovascular and metabolic diseases.

Management options:

 Multidisciplinary approach with preconception counseling.

 Weight loss and optimal BMI maintenance.

 Preconception screening and management of diabetic complications.

 Tight glycemic control.

 Optimizing HbA1c before the start of ART.

 The use of antibiotics should be considered with oocyte retrieval.

 Men with diabetes should get their androgen status checked if symptomatic of hypogonadism especially if taking statins.

 Treatment of erectile dysfunction.

 If the female partner is on statin therapy, check serum lipid profile and consider stopping treatment during ART and pregnancy.

 If the female partner has undergone bariatric surgery, wait for at least 12 months before embarking on IVF unless there were pressing reasons to act early.