For eight years, a 34-year-old woman had been trying to become a mother. Married for 11 years, she had already experienced two miscarriages. By the time she reached a fertility care centre, several pieces of a complicated puzzle had emerged: obesity, a low ovarian reserve, meaning fewer eggs were available than expected for her age, and an untreated thyroid condition called hypothyroidism, in which the body does not produce enough thyroid hormone, affecting metabolism. Then another finding changed the conversation.Her random blood sugar was 224 mg/dL and her HbA1c (average blood sugar count of three months) was 7.1%, consistent with previously undiagnosed Type 2 diabetes. Her 38-year-old husband also had a fertility problem, with a low sperm count and a higher proportion of abnormally shaped sperm.The couple’s case therefore involved several factors affecting their chances of having a baby, rather than a single cause of infertility. This is where IVF (in vitro fertilisation) can play an important role. IVF is a fertility treatment in which an egg and sperm are brought together in a laboratory to create an embryo, which is then placed in the uterus. In complex cases, it can give doctors greater control over the timing of treatment and allow different fertility challenges to be addressed together.Also Read | High blood sugar in pregnancy often stems from childhood, says study: How diabetes risk passes silently from mothers to childrenFor this couple, however, IVF was not a treatment for diabetes. The priority was first to assess and improve her overall health, including her blood sugar and thyroid function, while also determining the most appropriate fertility approach.How diabetes affects fertilityDiabetes does not automatically cause infertility. However, insulin resistance and associated hormonal disturbances can affect reproductive function in some women, particularly when conditions such as polycystic ovary syndrome (PCOS) or irregular ovulation are also present. Obesity and metabolic dysfunction can add further challenges.A woman with diabetes may conceive normally, but poorly controlled blood glucose around conception can increase the risk of pregnancy complications. This is why diabetes management should ideally begin before pregnancy rather than after a positive test.Story continues below this adDiabetes is therefore best understood as one potential piece of the fertility puzzle. Hypothyroidism can affect metabolism, weight and lipid levels, while insulin resistance and obesity are important contributors to type 2 diabetes. Thyroid dysfunction can also affect menstrual and reproductive function, making its diagnosis and treatment important before pregnancy.How to plan your pregnancy?Current guidance recommends that women with diabetes planning pregnancy aim for an HbA1c below 6.5%, when this can be achieved safely without problematic hypoglycaemia. Better glucose control before conception helps reduce pregnancy risks.Also Read | Insulin resistance and infertility: Why young Indians are struggling to conceiveThis is particularly important because early foetal development begins before many women know they are pregnant.For the woman in our case, preconception assessment became an important part of fertility treatment. Her diabetes, thyroid function, medications and weight-related risks were reviewed, and glucose-lowering treatment was individualised under endocrinology supervision.Story continues below this adHow IVF can be an enablerThe couple’s fertility journey also illustrates an important misconception: IVF does not cure diabetes. Its role is to provide a structured pathway to conception while allowing fertility and medical teams to coordinate treatment around the patient’s overall health.The first attempt to stimulate her ovaries did not produce enough eggs, so the treatment was stopped. Because she had a low ovarian reserve, the couple was then counselled about using donor eggs for IVF. Her husband’s low sperm count and abnormal sperm shape also meant that ICSI (Intracytoplasmic Sperm Injection), a technique in which a single sperm is directly injected into an egg to help fertilisation, was used.Also Read | What is the link between pregnancy and diabetes?The treatment resulted in three good-quality embryos. Two were later placed in her uterus after her body was medically prepared for pregnancy. The couple was counselled beforehand about the additional risks associated with a twin pregnancy.But the embryo transfer was only one part of the plan.Story continues below this adHer HbA1c improved from 7.1% at diagnosis to 6.8% around the time pregnancy was confirmed and 6.3% at six weeks. These values reflected improving glucose control, but also underlined why optimisation should ideally begin before conception rather than after pregnancy has started.Diabetes affects more than pregnancy—and may matter for men tooThe diabetes-fertility conversation often focuses on women because of the well-established risks associated with diabetes during pregnancy. But male reproductive health deserves attention as well. Research suggests that diabetes and chronic hyperglycaemia may affect sperm quality and reproductive function through mechanisms including oxidative stress, hormonal disturbances and impaired sperm function. That is why fertility assessment should be couple-centred.The woman’s pregnancy required continued vigilance. The focus shifted from preconception optimisation to protecting both mother and babies. The twin pregnancy was managed through multidisciplinary antenatal care, including intensive glycaemic monitoring, a procedure to help prevent early delivery, along with regular scans to monitor the babies’ growth and health. The pregnancy reached 37 weeks, when an elective caesarean delivery resulted in two healthy babies.For someone with diabetes who is considering pregnancy, preparation should go beyond checking whether conception is possible. Preconception care may include reviewing HbA1c and glucose patterns, medications, thyroid function, blood pressure, kidney and retinal health, nutrition and weight-related risks. Both partners should be evaluated when conception is delayed.Story continues below this adDiabetes does not automatically close the door to parenthood. Nor should every fertility problem in a person with diabetes be attributed to blood sugar. But diabetes does make planning more important.(The author is fertility specialist and Director, Indira IVF)