style="font-size:15px;"> 3 Q3 Can I have a normal delivery, or will I need a cesarean section? A3. This very much depends on your cardiac condition. For most women with cardiac disease a vaginal delivery is appropriate; however, for women with severely impaired ventricular function, for example, a cesarean section may be necessary. Your specialist team will advise you what is best for you and your baby.
References
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12 The patient with diabetes
Mohammed A. Khan1,2, Neelam Potdar3, and Justin C. Konje1,2
1 Women’s Clinical Management Group, Sidra Medicine, Doha, Qatar
2 Weill Cornell Medicine-Qatar, Doha, Qata
3 Women’s Hospital, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
Case History 1: A 30‐year‐old woman with primary infertility of 3 years and previous failed attempts at intrauterine insemination (IUI) was reviewed for IVF treatment. She was known to have type 1 diabetes. Her body mass index (BMI) was 24 kg/m2 and HbA1c 12%. Her partner had normal semen analysis. She was referred to the endocrinologist for tighter glycemic control, following which IVF treatment was commenced. On the day of oocyte retrieval her fasting blood sugar was 10 mmol/L and her HbA1c was 8%. The serum estradiol level before oocyte retrieval was 10,120 pmol/L and 12 oocytes were retrieved, of which nine fertilized. She complained of abdominal bloating, nausea and a smelly vaginal discharge from day 5 after the retrieval.
Case History 2: A 39‐year‐old male with type 2 diabetes on oral hypoglycemics and prophylactic simvastatin presented to the assisted conception clinic. His BMI was 36 kg/m2 and semen analysis showed severe oligozoospermia. His complaints were reduced libido, mild erectile dysfunction (ED) and constant fatigue. Physical examination was normal and repeat semen analysis confirmed oligozoospermia. His HbA1c was 9% at presentation, serum FSH 3.4 IU/L, LH 4 IU/L, testosterone 3 nmol/L; karyotype and cystic fibrosis screening were normal. Investigations for the female partner were all normal.
Background
In general, patients undergoing assisted reproduction techniques (ART) are healthy individuals, but due to a rise in the prevalence of diabetes mellitus and impaired glucose tolerance globally over recent decades [1], it is not uncommon to see more and more diabetic couples seeking ART. For those providing ART, managing such couples is challenging, especially if the patient has type 1 or poorly controlled diabetes.
In animals, studies have shown that (a) diabetes is associated with ovarian atrophy, poor follicular development, impaired steroidogenesis and reduced progesterone levels [2], and (b) insulin administration corrects impairment of in‐vitro oocyte maturation and early pre‐embryonic development [3]. In women with well‐controlled type 1 (insulin dependent) diabetes, response to gonadotropin stimulation, fertilization and cleavage rates have been shown to be the same as those in women without diabetes [4,5]. The follicular fluid milieu in patients with well‐controlled type 1 diabetes is almost the same as in women without diabetes, except for the absence of epidermal growth factor.
In
