How Chronic Conditions Impact Fertility

The male and female reproductive systems are engineering marvels. To function optimally, both rely on an equisite balance of precisely timed hormonal messages and the peak performance of the reproductive organs. Unfortunately, a chronic health condition such as diabetes or thyroid disease can sometimes snarl these intricate reproductive works. Aggressively treating conception-threatening conditions before you're ready for a baby is your best insurance against infertility. Here's a list of the chronic conditions you need to get under control now.

Diabetes. Type 2 diabetes (also called adult-onset diabetes) is linked to obesity and insulin resistance, both of which can cause hormonal upsets in women, out-of-whack menstrual cycles, and infertility.

Type 1 diabetes (sometimes called juvenile-onset or insulin-dependent diabetes) develops when the insulin-producing cells of the pancreas are destroyed by autoantibodies. This process may cause the body to make antibodies that attack other endocrine organs, including the ovaries. The result may be a depletion of eggs and early menopause.

Blood sugar is difficult to control with type 1 diabetes because all of the insulin the body needs must be given by injection. If you do conceive, diabetes can seriously harm your baby if you haven't yet reined in high blood sugar. Women with poorly monitored preexisting diabetes in the early weeks of pregnancy are two to four times more likely to have a baby with birth defects, incudling neural tube defects like spina bifida. They're also at greater risk of miscarriage, stillbirth, or high-birth-weight babies that are difficult to deliver. If you develop gestational diabetes later in pregnancy, you boost your odds of having a larger than normal baby or one with birth defects.

Diabetes affects male fertility as well. Diabetic men often experience retrograde ejaculation in which semen enters the bladder instead of being ejaculated through the penis into the female reproductive tract where it can fertilize eggs. Diabetes also can cause erectile dysfunction.

High blood pressure. "The relationship between chronic hypertension and infertility isn't clear," notes Kaylen M. Silverberg, MD, medical director of the Texas Fertility Center in Austin and obstetrics and gynecology professor at the University of Texas Medical Branch in Galveston and the University of Texas Health Science Center at San Antonio. Chronic hypertension does, however, appear to contribute to infertility in certain people (one reason may be the conception-thwarting impact of high blood pressure drugs).

Having uncontrolled high blood pressure while you're pregnant -- either because it wasn't under control before conception or because it develops afterward (a condition known as preeclampsia) -- can invite serious complications, including constriction of blood vessels in the uterus that cuts off oxygen and nutrients to your baby; separation of the placenta from the uterine wall, which may lead to heavy bleeding and shock; and eclampsia, a life-threatening complication of preeclampsia, which may include convulsions and coma.

Thyroid disease. Having an underactive thyroid gland (hypothyroidism) or an overactive one (hyperthyroidism) can scramble your ovulation cycles and short-circuit your ability to conceive. Hypothyroidism may also be associated with an autoimmune response in your body, signaling it to manufacture antibodies that attack your ovaries and lead to premature menopause.

Autoimmune disease. Like diabetes and thyroid disease, autoimmune conditions such as lupus (which is accompanied by arthritis-like stiffness and fatigue) also sometimes produce antibodies that attack your body, including your ovaries.

Anemia. While there's no direct link between anemia and infertility, the root causes of anemia occasionally spark fertility problems. "If a woman is anemic because she's malnourished or has an eating disorder, she may have disrupted ovulation," notes Dr. Silverberg. "If she's anemica because of heavy bleeding from a benign fibroid tumor in her uterus, the fibroid may be contributing to her infertility."