At 5.30 am, before the city stirred, Anupama sat on the edge of her bed with a glucometer in one hand and a pregnancy test strip in the other. Her fasting glucose reading was slightly higher than the previous week — not alarming, but enough to unsettle her. On the bedside table lay syringes, hormone vials, and a notebook filled with tightly logged numbers: blood sugar levels, medication doses, cycle days. Each entry was an attempt to bring order to a process that often felt unpredictable.
At 37, the Kochi-based advertising manager was in the middle of an assisted reproductive technology (ART) cycle after three years of infertility treatment. She had grown used to the routines — injections at precise hours, scans that tracked progress in millimetres, and the quiet anticipation after every consultation. What she had not expected was how central her insulin levels would become.
“I thought the hardest part would be the treatment itself,” she says. “I didn’t realise how much attention I’d have to give to my metabolism.” Her experience reflects a growing shift in fertility care, where metabolic health is no longer seen as separate from reproductive outcomes. Doctors increasingly observe that insulin resistance — common in women with polycystic ovary syndrome (PCOS), prediabetes, or obesity — can influence ovulation, egg quality, and even the uterus’s readiness for implantation.
Dr Suhasini Inamdar, consultant at Motherhood Hospitals in Bengaluru, says this adds another layer to an already demanding process. “Patients are already following strict protocols. When insulin resistance is involved, it introduces an additional variable that needs close monitoring. Diabetes and polycystic ovaries often go hand in hand, as both are hyperinsulinemic states.”
For many women, this overlap creates a dual discipline. Alongside fertility appointments, they begin to track meals, plan exercise, and monitor glucose levels with the same focus they once reserved for ovulation cycles. Food becomes deliberate. Daily routines are adjusted in response to numbers that fluctuate despite best efforts.
Anupama encountered this shift midway through her treatment. “I was following everything carefully, and then my doctor pointed out that my insulin levels were borderline,” she recalls. “It felt like I had to recalibrate everything.”
Overcoming this challenge is rarely quick; it is a gradual process. The focus extends beyond the clinic to the kitchen and the gym, where every meal and every walk becomes part of preparing the body for pregnancy. For many, this phase is among the most demanding parts of ART.
Dr Reji Mohan, associate professor in reproductive medicine at Sree Avittom Thirunal Hospital for Women and Children in Thiruvananthapuram, highlights the psychological strain. “Many patients are already dealing with obesity and emotional stress after a long period of infertility. We encourage sustainable habits. Small, steady changes tend to be more effective,” Dr Reji Mohan explains.
For Anupama, that meant manageable adjustments rather than drastic ones. She began spacing her meals, taking short walks after eating, and checking her glucose levels regularly without letting the numbers dictate her mood. Over time, her readings stabilised — not dramatically, but enough to offer a clearer path forward. Even with careful planning, ART outcomes are never guaranteed. Her first embryo transfer did not succeed — a result that is clinically common but emotionally difficult. She paused, reassessed, and prepared again.
In her next cycle, the approach was more calibrated. Her care plan included closer metabolic monitoring alongside fertility treatment. By the time Anupama reached her second embryo transfer, her insulin levels were better controlled and her approach steadier. When the pregnancy test finally showed a positive result, it did not erase the difficulty of the journey, but it marked a moment where sustained effort and medical support aligned.