Metabolic fertility – How metabolism shapes reproductive health

You may have heard a doctor talk about metabolic fertility when bringing up discussions around difficulties conceiving, infertility, and overall health and wondered how your metabolism impacts the body’s reproductive process.

What is metabolic fertility? It’s a newer concept that examines how metabolic health influences reproductive health and outcomes. Metabolic fertility is about addressing one of the root causes of fertility challenges, metabolic issues, and how improving metabolic disorders through various pathways to overcome fertility challenges either without IVF, or undergoing fewer IVF cycles.

It includes the exploration into the association between fertility and metabolic issues, including the rising rates of polycystic ovarian syndrome, increasing numbers of people with insulin resistance, and higher numbers of individuals with metabolic syndrome.

Keep reading to better understand metabolic fertility and the role metabolism (and metabolic dysfunction) plays in fertility-related conditions.

What is metabolic fertility?

Metabolic health refers to how well the body creates and uses energy from food to run the body optimally. When important metabolic factors operate well and are in healthy ranges — like insulin, blood pressure, blood sugar, and bodyweight — they’re priming the body for good health.  A metabolic system that’s operating well supports the reproductive system.

Metabolic fertility is an analysis into the link between metabolic health and how metabolic disorders and challenges impact fertility. Someone who has metabolic risk factors or a metabolic disorder might experience increased challenges around fertility.

Important metabolic factors that affect fertility include:

• Inflammation levels: Chronic inflammation is tied to endometriosis, PCOS, and obesity.
• Insulin and blood sugar regulation: Women with PCOS are likely to have a higher likelihood of insulin resistance. High insulin levels can throw reproductive hormones out of whack in men and women, making it harder to conceive and/or maintain a healthy cycle.‍
• Mitochondrial function and energy balance: Variants in mitochondrial function have been associated with male fertility issues.‍
• Hormone metabolism: Disruptions in how the body processes hormones (estrogen, progesterone, testosterone, and cortisol) can interfere with ovulation, menstrual cycles, and sperm function. Metabolic testing that examines this can help.

Metabolic factors that impact fertility

When someone experiences metabolic issues, it can increase the risk of fertility disorders through its impact on menstrual cycles, ovulation, and hormone regulation. Some of the most common infertility disorders — PCOS and endometriosis — have associations with metabolic dysfunction. 

Insulin resistance and PCOS‍

When the body is not responding well to insulin — experiencing insulin resistance — it impacts blood sugar and causes hormone imbalances. This could be a cause of PCOS and the ensuing imbalances that lead to the body stopping ovulation and/or irregular periods that make it harder to get pregnant.

Obesity and energy imbalance

The relationship between obesity and fertility is one that may come up in fertility discussions. Obesity has also been shown to impact egg production due to insulin resistance factors. Excess weight impacts the male’s health in that fat cells can convert testosterone into estrogen, impacting sperm production.

Thyroid and adrenal health

Thyroid disorders and autoimmune diseases can also impact fertility since they can directly impact one’s cycle. Adrenal insufficiency has also been associated with reduced fertility, as the adrenal glands play an important role in metabolic processes. 

Inflammation and oxidative stress

Chronic high inflammation can increase oxidative stress and damage cells, disrupting various metabolic systems, and may also negatively affect reproductive tissues, including the uterus.

How to improve metabolic fertility

Fortunately, there is a lot that can be done to improve one’s metabolic health to prime yourself for improved fertility. Improving metabolic health during the Premester — the 3 to 12 months before conception — can shorten time to pregnancy and lower risks. Here's where to start:

‍Eat healthier

Optimizing your nutrition can boost fertility. Ensuring that you’re getting the targeted nutrients your body needs can support fertility. Consider adopting an anti-inflammatory diet, in particular one that follows Mediterranean eating patterns and keeps glucose levels stable. Since high blood glucose levels are linked to metabolic dysfunction, eating a diet that keeps levels mostly stable may help improve overall fertility.

Increase exercise and movement‍

While this isn’t necessarily the time to start your marathon training, regular movement helps the body reduce inflammation, improve insulin sensitivity, and balance hormones — all important for better metabolic fertility. Some ways to move more include strength training (body weight resistance or with weights), walking or cardio exercise, as well as getting in more NEAT (non-exercise activity thermogenesis). That means moving around more throughout the day and sitting less to keep your metabolism humming.

Focus on improving sleep

‍Not getting enough sleep or quality sleep isn’t just affecting your mood, it disrupts metabolism. Short sleep throws off appetite hormones, can raise blood sugar, and is associated with negative reproductive system outcomes. Work on establishing a regular bedtime routine and try to stick to a similar schedule each night — aiming for seven to nine hours each evening.

Reduce stress

You probably think you don’t need to hear “reduce stress” one more time when it comes to fertility but, it’s important to note that chronic stress activates the brain’s pituitary gland, impacting reproductive hormones like follicle stimulating hormone (FSH) and luteinizing hormone (LH). Finding things to do that reduce your stress — whether that’s slow breathing, listening to music, reading, movement, connecting with a loved one — can go a long way to helping reduce cortisol surges and get your physiological systems back in check.

Look into GLP-1 receptor agonists (GLP-1s)

‍These medications can have a positive impact on metabolic health by reducing appetite and regulating blood sugar which can lead to weight loss and improved metabolic control. Early research is showing that in people with insulin resistance, obesity-related fertility issues, and PCOS, semaglutide drugs could be an intervention that shows promise.

Metabolic fertility for women

When it comes to improving metabolic fertility for women, your healthcare team might bring up how the following areas that could be enhanced with metabolic interventions and emerging therapies.

• Egg quality and ovarian function. Better quality eggs and optimally-functioning ovaries and menstrual cycles can help with fertility rates.
• PCOS interventions can help improve fertility. Early intervention in someone with PCOS can increase the person’s chance of getting pregnant. Controlling PCOS with a team of experts who can help lifestyle management and cycle control can greatly improve one’s chances of conceiving in patients with PCOS. 
• Reducing body weight can make an impact. A 5% decrease in weight can lead to more predictable ovulation. 
• Pregnancy preparation: The Premester is about understanding and improving preconception health — the window of time before pregnancy — to increase your chances of having a healthy pregnancy. Making small changes during this time, like eating healthier, getting more sleep, being active, reducing stress can improve fertility and lead to a healthier pregnancy and delivery.

Metabolic fertility for men

The man’s fertility and overall health is a crucial part of fertility and creating a healthy baby. Here’s what to know about metabolic fertility for men. 

• Sperm quality and metabolic health: Hormone issues and metabolic dysfunction can lead to lower sperm motility (how well the sperm move), quantity, and morphology (which includes the size, shape, and appearance of sperm).
• How metabolic health affects testosterone and hormone balance: High insulin can increase estrogen and lower testosterone in men which makes it harder to produce healthy, viable sperm. Having excess weight can also cause testosterone to convert to estrogen.
• Lifestyle interventions are important for male fertility: Sperm are very sensitive to oxidative stress which can damage cells. Improvements in diet, quitting smoking, working toward better blood sugar balance and reducing body weight can all have a positive impact on sperm health as well as hormone production.
• The Premester is an important time for him: An improved diet is associated with better sperm quality, which is why some urologists suggest a more plant-focused diet for men and to reduce added sugars and processed foods. Improving metabolic health for men before conception looks like getting to a healthy weight as obesity negatively impacts sperm health. Avoid cigarette smoking, marijuana use, and excessive drinking.

Emerging science on metabolic fertility

Scientists and healthcare professionals continue to explore various metabolic health markers and how they impact fertility. Some topics that show promising developments include:

• Research into mitochondria and oocyte quality. Emerging science looks into the relationship between mitochondria and oocyte quality. Healthy mitochondria give eggs the energy they need to mature and fertilize properly. When that energy supply falters, egg quality declines and fertility can suffer. 
• Microbiome's role in metabolic and reproductive health. A healthy gut microbiome can support optimal ovulation, better reproductive processes, as well as pregnancy outcomes.
• Personalized metabolic testing as part of fertility treatment. Comprehensive testing that looks at hormone panels, advanced insulin tests, as well as addressing genetic and epigenetic factors can result in a personalized health treatment plan that’s unique to your needs and lifestyle

Frequently asked questions about metabolic fertility

What is metabolic fertility?

Metabolic fertility is an exploration into the science behind how your body’s metabolism affects fertility. Since certain fertility problems start with metabolic issues — like PCOS, insulin resistance, and obesity to name a few — people with metabolic risk factors may find it harder to conceive.

Can improving metabolism help with unexplained infertility?

Yes, improving metabolism and metabolic health overall may help with unexplained infertility if the issues were related to hormone imbalances, irregular cycles, insulin resistance, blood glucose and blood pressure issues.

How does insulin resistance affect fertility?

Insulin resistance impacts energy. In women with insulin resistance, fertility can be impacted by ovulation disruption, hormone imbalances, and irregular periods. In men, high insulin levels can reduce sperm count, impact how they are shaped, and testosterone levels.

What lab tests show metabolic health for fertility?

The lab tests that can indicate metabolic health changes might need to be made for fertility improvements are inflammatory marker tests, hormone panels, standard blood panels, insulin tests, as well as genetic tests that can indicate challenges with metabolic processes

What lifestyle changes support metabolic fertility?

There are a number of lifestyle changes that can support metabolic fertility. They include: sleep improvements, stress reduction, increasing exercise and activity, making dietary changes that can regulate blood sugar, as well as addressing nutrient deficiencies. Taking the time to make these changes can improve outcomes.

Does metabolic fertility apply to men too?

Yes, metabolic fertility can impact men. Metabolic dysfunction could result in issues with testosterone production, sperm health and production, and impact other reproductive components that are important to fertility.

Do GLP-1s help with fertility?

Although it’s in early stages of research examining the relationship into GLP-1s (GLP-1 receptor agonists) possibly helping with fertility, these medications designed to help with type 2 diabetes are showing better metabolic control in people with obesity, PCOS, and those with insulin resistance. Since they may help with weight loss, this could possibly help with fertility, particularly in individuals with obesity-related fertility issues. 

Metabolic fertility can make a difference

Metabolic fertility looks at how metabolic health influences reproductive health. It’s a fast- growing, evidence-backed concept that’s being explored from numerous angles via blood tests, lab tests and lifestyle changes to better understand how positive changes to one’s metabolic health could lead to better fertility outcomes.

Metabolic interventions can benefit both fertility and overall health. Talk to a healthcare professional who’s on your fertility team if you want to learn more about how metabolic health improvements could enhance your fertility outcomes. 

‍Carrot suggests individuals focus on the Premester preparation phase – the 3 to 12 months before a positive pregnancy test – and to incorporate some healthy lifestyle modifications during this time. You can do this through Sprints, Carrot’s clinically backed program that prioritizes nutrition, sleep, stress reduction, and movement to improve metabolic fertility.

Sprints prioritizes metabolic fertility in men and women, designed to make it easier to achieve pregnancy through intercourse or improve IVF success rates. The metabolic fertility support program is designed to significantly reduce physical and emotional stress while helping to build healthier habits, stay engaged throughout the process, and make meaningful progress toward pregnancy.