Insulin resistance-diabetes risk

You are at high risk for insulin resistance; this causes ovarian dysfunction, implantation failure, and pregnancy loss

Here is what you need to know:

Insulin resistance has been associated with recurrent pregnancy loss (RPL) and Recurrent implantation failure (RIF). Insulin resistance can be assessed with various methods. An easy and clinically helpful method is the calculation of HOMA-IR (Homeostasis Model Assessment of Insulin Resistance). It is a robust tool used in many studies to assess IR and its correlation with RPL and RIF. HOMA-IR greater than 1.9 is consistent with insulin resistance. Insulin resistance, of course, is the precursor to the development of diabetes. People may suffer from undiagnosed insulin resistance for 10 years before they are diagnosed with diabetes.

Causes and effects of insulin resistance:

Causes of insulin resistance include obesity, genetic predispositions, polycystic ovarian syndrome (PCOS), poor dietary habits, and sedentary lifestyles, among other causes. In humans, insulin resistance affects all tissues except the ovarian granulosa cells.

Ovarian granulosa cell insulin sensitivity remains normal in patients with insulin resistance (IR). Myoinositol (MI) and dichiroinositol (DCI) are essential for proper ovarian function. One study reported higher MI/DCI epimerase activity in theca cells from PCOS compared to control women. In this study, mean values of MI/DCI epimerase activity in PCOS were about three times higher than in controls, while the MI/DCI ratio was 3–4 times higher in controls than in PCOS women.

Effect of excess insulin on ovarian epimerase:

Epimerase converts MI to DCI, and in regular patients, the follicular MI/DCI is 40:1. In patients with IR, because granulosa cells remain sensitive to insulin, epimerase activity increases significantly. Increasing amounts of MI are converted to DCI, leading to an imbalance in the MI/DCI ratio. In another study, in healthy women, the MI/DCI in the follicular fluid was 100:1, and in women with PCOS, the ratio in the follicular fluid was 0.2:1.

Restoring the ovarian ratio with supplementation of MI/DCI at a 40:1 ratio improves the number and quality of eggs produced. Such a benefit is also achievable in women suffering from insulin resistance without PCOS.

Restoring insulin sensitivity is essential to improve ovarian function with an improved number and quality of eggs. The use of Metformin with or without Berberine with InSea2 (a nutritional supplement) is an essential tool in the normalization of insulin sensitivity and the restoration of standard glucose tolerance.

Insulin resistance causes implantation failure:

Insulin resistance is associated causatively with implantation failure and recurrent implantation failure. In addition, once you conceive, you are at increased risk for pregnancy loss; if the pregnancy proceeds well, you have an increased risk of developing gestational diabetes and other pregnancy complications such as preeclampsia. Your primary care doctor should screen you for gestational diabetes at 14-16 weeks gestation and if negative, repeat the test at 26 weeks. It would be best if a high-risk obstetrician followed you to reduce the risk of serious complications.

What you need to do:

Correcting insulin resistance before conception or egg retrieval will increase your chances of getting high-quality eggs and having successful implantation and pregnancy.

Adapting a healthy Mediterranean diet before and during pregnancy will be very helpful in correcting your insulin resistance. Metformin and Berberine with InSea2 supplementation twice a day improves glucose insulin sensitivity. Please speak to your primary care doctor and provide this information to him/her.  You should have a fasting plasma blood sugar, a fasting plasma insulin, and an HbA1c (glycosylated hemoglobin).

Dr. Kofinas treats his patients with supplements that rejuvenate ovarian function and improve egg quality in three to six months. This benefit is confirmed based on the improvement of day 3 hormonal changes from the baseline before supplementation. You may request such supplements if you wish, and we can order them for you.