Managing blood sugar levels can improve fertility issues, study says

According to the findings of a recent study published in the Journal of Endocrinology, reducing blood glucose levels may partially restore reproductive hormone levels in obese females, leading to enhanced fertility.

The findings suggest that a popular type 2 diabetes medicine that lowers blood glucose levels can partially restore abnormal levels of reproductive hormones in a well-established mouse model of obesity. Many obese women who have fertility problems have changed amounts of reproductive hormones. There is currently no effective treatment for this.

The discovery of a medicine that not only improves women’s metabolic health but also addresses obesity-related infertility would be a big step forward, potentially improving the quality of life for many individuals.

Although reproductive issues in obese women are widely known, there is a lack of effective and tailored treatments to address them. Obesity is an increasing health problem, which implies that more women are experiencing reproductive issues.

Obesity-related fertility concerns are complicated, but data shows that they are connected in part to changes in energy metabolism, which lead to changed levels of reproductive hormones, which can subsequently disrupt the menstrual cycle and ovulation.

The MC4R gene knock-out (KO) mouse is a well-characterised model of obesity, which also exhibits irregular reproductive cycles with altered hormone levels that lead to declining fertility. The mouse reproductive cycle is similar to that of humans, in that the profile of hormone level changes is analogous, although it is much shorter in duration, so the MC4R KO mouse is a good, representative model for initial investigations of metabolic and reproductive function in obesity.

Dapagliflozin is a drug commonly used to treat type 2 diabetes, where it reduces blood glucose levels and improves other markers of metabolic health but its effects on reproductive health and fertility have yet to be investigated.

In this study, Professor Chen and colleagues at the University of Queensland in Australia investigated the effects of dapagliflozin treatment on metabolic health and reproductive hormone levels in the MC4R mouse model of obesity. After just 8 weeks of treatment blood glucose levels were normal, body weight was reduced, the reproductive cycle was normalised and levels of reproductive hormones and ovulation were partially restored, compared with non-treated mice.
“We often see low fertility in women with obesity in clinical practice”, comments primary author, Dr Cui, a visiting fellow from Chengdu Women and Children Hospital in China, “so this research provides hope for a future, effective treatment.”
Professor Chen comments, “These data suggest that normalising blood glucose metabolism with dapagliflozin in obesity may be a promising route for at least partially restoring reproductive function. This could improve fertility in women where no other successful therapy is currently available.”

However, Professor Chen cautions, “Although encouraging, these studies were conducted in mice and much more work needs to be done to confirm that these findings could be replicated effectively in women. However, people with obesity are at much greater risk of developing type 2 diabetes, so the known health benefits of correcting blood glucose levels may be extended to also improving fertility in those affected.”

The team now intend to further investigate the therapeutic benefits of using dapagliflozin to improve reproductive function by examining the molecular pathways involved, which could identify better targets for future fertility treatment in women.

How can I treat high blood sugar?

Talk to your doctor about how to keep your blood sugar levels within your target range. Your doctor may suggest the following:

• Be more active. Regular exercise can help keep your blood sugar levels on track.
• Take medicine as instructed. If your blood sugar is often high, your doctor may change how much medicine you take or when you take it.
• Follow your diabetes meal plan. Ask your doctor or dietitian for help if you’re having trouble sticking to it.
• Check your blood sugar as directed by your doctor. Check more often if you’re sick or if you’re concerned about high or low blood sugar.
• Talk to your doctor about adjusting how much insulin you take and what types of insulin (such as short-acting) to use.

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