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.
Answers to questions patients ask
1 Q1 Why do diabetic women need preconception care and counseling (PCC)?A1. Poorly controlled diabetes is associated with poorer pregnancy outcomes compared with that in women without diabetes or those with diabetes that is well controlled. These can be minimized with PCC that aims to optimize not only your diabetic control but your general health, making pregnancy less risky.
2 Q2 What are the potential benefits of PCC? A2. In addition to reducing the risk of anomalies in the offspring, PCC aims to achieve optimum control of diabetes to avoid the damaging effects of diabetes on other organs especially heart, kidneys and eyes which could further deteriorate with pregnancy if ignored.
3 Q3 Why should IVF treatment for diabetic women differ from that of nondiabetics? A3 .Diabetic women have problems with insulin production or function which complicates metabolism with damaging effects on the body including the endocrine system. Ovarian stimulation and embryo development including implantation and maintenance of pregnancy can therefore be challenging and risky in diabetics. The risk further increases in poorly controlled diabetes.
4 Q4 What does preconception optimum glycemic control mean? A4. Optimum glycemic control is an indicator of overall control of diabetes which is required before conception. Generally, HbA1c level of between 6–7% indicates optimum glycemic control over the last 8–12 weeks.
5 Q5 I have recently undergone bariatric surgery for weight loss and control of diabetes; when can I have IVF?A5. It takes a minimum of 12–18 months for the full benefits of bariatric surgery to become evident including optimum weight loss and metabolic stability. The recommendation is to wait at least 12 months before planning to conceive unless there were convincing reasons to act early such as advanced female age with low ovarian reserves.
References
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