Insulin resistance-diabetes risk

You are at high risk for insulin resistance; this causes ovarian dysfunction, implantation failure, and pregnancy loss or late pregnancy complications. Here is what you need to know.

Insulin resistance has been associated with both, Recurrent pregnancy loss (RPL) and Recurrent implantation failure (RIF). Insulin resistance can be assessed with various methods. An easy and clinically useful method is the calculation of HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) which is a robust tool and is 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 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 important 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. (Carlomagno et al., 2011, 2015; Di Nicola et al., 2014; Unfer and Porcaro, 2014), (Heimark et al., 2014)

Epimerase converts MI to DCI and in normal patients, the follicular MI/DCI is 40:1. In patients with IR, because granulosa cells remain sensitive to insulin, epimerase activity increases significantly and increasing amounts of MI are converted to DCI. 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. (Unfer et al., 2014).

Restoring the ovarian ratio with supplementation of MI/DCI at a 40:1 ratio improves the number and quality of eggs produced. Such benefit is achievable also in women suffering from insulin resistance in the absence of PCOS.

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

Insulin resistance is associated in a causative manner 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 to develop 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. You must be followed by a high-risk obstetrician to reduce the risk of serious complications.

What you should do: Correcting insulin resistance prior to conception or prior to egg retrieval will increase your chances of getting high-quality eggs and having successful implantation and pregnancy. Adapting a healthy Mediterranean diet prior to pregnancy as well as during the pregnancy will be very helpful in correcting your insulin resistance along with Metformin and Berberine with InSea2 supplementation twice a day. 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 a period of three to six months. This benefit is confirmed based on the improvement of day 3 hormonal changes from baseline prior to the onset of supplementation. You may request such supplements if you wish, and we can order them for you.