Uncontrolled diabetes may cause a transient decrease in ovarian reserve parameters to a suboptimal level: Recovery with optimized glycemic control – A case report

In this case report, we review a patient in whom ovarian reserve parameters increased significantly following treatment of uncontrolled diabetes. The patient is a previously healthy, lean 29-year-old woman in a same-sex relationship who was seen at a fertility clinic interested in pursuing treatment with donor sperm. Baseline fertility investigations were completed to ascertain the patient's ovarian reserve and candidacy for intrauterine insemination versus in vitro fertilization. Baseline fertility investigations revealed diminished ovarian reserve putting her at risk for a suboptimal response, with anti-Müllerian hormone level 1.5 ng/mL and antral follicle count 14. Following two unsuccessful cycles of donor sperm intrauterine insemination, the patient presented to the emergency department in diabetic ketoacidosis with hemoglobin A1C 12.3% and random glucose 20.3 mmol/L. She was diagnosed with type 1 diabetes and treated with insulin lispro and bolus insulin. Hemoglobin A1C improved to 6.0% over several months. When she returned to the fertility clinic one year after initial presentation, anti-Müllerian hormone had increased to 7.0 ng/mL and antral follicle count to 44 when performed in the original laboratory and ultrasound unit. We surmise that uncontrolled diabetes may be a cause of spuriously decreased ovarian reserve parameters, which may improve with optimized glycemic control. Further studies are needed to confirm this finding.