How does insulin resistance affect fertility? (Plus other key questions, answered by a lifestyle medicine practitioner)
The short answer — insulin resistance can affect fertility by leading to cycle changes, ovulatory dysfunction, and hormonal imbalances.
But, hormones are just one puzzle piece when it comes to your health, and that’s where lifestyle medicine can be a really empowering tool for those of us looking for support.
In this IG Live, TRB Founder Eloise chats with Dr. Shivanthy Sivasothy, GP and Hormone & Metabolic Health Expert at The Ü Clinic, about the powerful ways everyday habits and lifestyle guidance can influence your metabolic and, consequently, reproductive health.
Dr. Shiv takes us through what metabolic health actually is, and why it’s so closely connected to hormones, cycles, energy, and fertility — especially for those of us dealing with PCOS, irregular periods, fatigue and stress.
Watch as we unpack:
- What metabolic health is and how it links to whole-body health
- How insulin resistance can affect fertility
- Early signs that your metabolic function might need some attention
- The role of lifestyle medicine, including practical ways to improve insulin sensitivity and blood sugar control
- Why (and how) stress, sleep, and gut health are all connected to hormonal balance
- Real-life examples of how The Ü Clinic builds personalised plans to support patients
- And much more
Whether you’re on a fertility journey or just want to feel better in your body, this Live is packed with expert perspective and top tips.
With locations across the South East of England, The Ü Clinic has a unique bespoke GP service, dedicated to working with you to help you achieve and maintain your health targets.
Ready to learn more? Hop over to The Ü Clinic’s website, and book a consultation with Dr. Shiv for a truly personalised approach to hormone and metabolic health.
Transcript
Eloise Edington
So, welcome everyone. Today I am about to be joined live by Dr. Shiv from the Ü Clinic to talk all about metabolic health, how that can impact your overall well-being, as well as, of course, your fertility. So, she should be here any second. Please do have your questions ready, and we can get started.
Hi to those who are joining. Welcoming Dr. Shiv in a minute to talk about metabolic health and how it impacts fertility. So please have your questions ready as we begin. You sent in some great questions, so we’re excited to get going with those once she joins. Just seeing where she is, and we can get started.
Okay. Just connecting now.
Hello, welcome!
Dr. Shivanthy Sivasothy
Hi, nice to meet you. Thank you for having me.
Eloise Edington
Of course. So, I’ve given a brief introduction about metabolic health — what we’re going to be talking about today to do with hormones, how lifestyle impacts your hormonal balances, and of course, fertility. So if you could please start by introducing yourself, tell us a bit about your background, and of course, The Ü Clinic.
Dr. Shivanthy Sivasothy
Okay, lovely. Thank you again for having me. I’m Dr. Shiv. I’m a GP specialist at The Ü Clinic, and my special interests are in metabolic health, hormone health, and lifestyle medicine.
What we focus on at The Ü Clinic is very personalised care. I use the knowledge bases from these areas of medicine to really help my clients look at the root causes of their problems, and then look at how we can create personalised solutions that are not just about a medical prescription, but also about a lifestyle.
Eloise Eddington
Fantastic. And we’ve had some great questions come in from our community that I’m going to be asking you a bit about today.
Dr. Shivanthy Sivasothy
Brilliant.
Eloise Edington
So first of all, could you explain what is metabolic health and why should someone think about it for their general well-being, but also for their hormones and how that might impact their fertility?
Dr. Shivanthy Sivasothy
It’s a really good question. So, metabolic health focuses on the key systems that affect our metabolism. Our metabolism is, very simply, how the body makes energy from the food we eat and then how we utilise that energy to support the vital functions in our body. Our hormones are very closely linked because the hormones are a complex signalling system in the body, and they are responsible for regulating those vital functions that the metabolism is fueling.
I think of the body as being a little bit like an orchestra. We are the conductors, and the different sections are made up by your metabolic health, your hormone health, your gut health — that’s important too. And when all of the systems are in harmony together, you’ve got this beautiful symphony. But when one is a bit out of tune, then the whole piece can go wrong. In that sense, when you have a dysfunctional metabolism, it’s often the underlying issue for hormone imbalance, and vice versa. Hormone imbalance, therefore, can underlie metabolic issues.
Eloise Edington
Gosh. So there are many layers to it, which we’re going to unpack a bit today. In terms of hormonal balance, from a lifestyle medicine lens, what does that look like in real life? Are there signs that someone’s system might be out of sync? And also, how does this differ between women and men?
Dr. Shivanthy Sivasothy
From thinking of this in terms of balance, I always talk about the systems because they are so interconnected. It’s really important to try and achieve balance in each of these systems. And I don’t really think it’s just about your hormones being within a normal range when you have a blood test. It’s about connecting with how you feel and whether things feel in sync.
So, lifestyle medicine comes into play here. The definition of it is that it’s a medical approach that’s focused on treating, preventing, and reversing chronic illness, looking at root causes, and applying what they call the six key pillars of lifestyle medicine. So that is: stress, diet, sleep, exercise, social connection, and reducing harmful substances. I think when we’re thinking of this from a hormone perspective, it’s really key to actually work on these six key pillars in order to achieve balance — in all areas of our health.
Eloise Edington
Absolutely. And it’s stressful in itself, isn’t it? Worrying that you are too stressed. And then obviously that can have a knock-on effect to sleep and vice versa. So these things obviously are very interlinked. And as you said, if one thing’s off-kilter, then it can mess up everything.
Dr. Shivanthy Sivasothy
Absolutely. And obviously, if you’re trying to conceive, you’re heightened to this because you want your body to be in the best shape it can be to conceive. And it’s so difficult with conception because actually we start to worry about: are these things right? Is my blood level right? Is this right? But actually what we’ve got to often do is look at those internal stress levels. Are there things that we can do to optimise those and reduce them — to help balance those hormones and make conception a bit more likely?
Eloise Edington
Absolutely. And do you see a lot of people at the Ü Clinic who come to you wanting to find out more about their hormonal balances?
Dr. Shivanthy Sivasothy
Yes, I think it’s one of my key areas. I’ve helped a lot of — it’s mainly women. I do help men as well. And you asked me — sorry, I didn’t actually answer the question — is there a difference between men and women?
The early symptoms of hormone imbalance and metabolic imbalance are very similar, and they’re very similar for men and women. That’s low energy, fatigue, weight gain, poor sleep, poor concentration. So it can apply to both genders. And in the clinic, that’s generally what I get a lot of people coming in to see me about — low energy or concerns about their weight or how they’re feeling, and whether their hormones are influencing that.
Eloise Edington
Because of course, also lack of sleep then impacts your food decision choices as well and how you’re feeling in the day and energy levels — which is also impacted by food. So I’m not surprised. Do you often find that people come to you because they’ve started to experience these symptoms, or are people trying to look at their overall general health to optimise how they’re feeling? Are there normally symptoms that they come with?
Dr. Shivanthy Sivasothy
Yes. So actually, as I said, the most common symptoms that people come to me with are excess fatigue, poor concentration, weight gain, and generally a subtle feeling of just “things have changed and things don’t feel right.” That’s another common one that people come to me for. It’s quite difficult when you go to your routine doctor to be able to have the time to explore those concerns — where they’re so vague and there are so many things that can underlie those symptoms. So yes, that’s often what people come in with: these niggling symptoms that they just can’t quite get on top of. And that’s where we help.
Eloise Edington
Amazing. Amazing. And in terms of insulin resistance — especially with infertility and PCOS — what other subtle signs might people have which suggest that blood sugar or metabolic function needs looking at?
Dr. Shivanthy Sivasothy
That’s a really good question. If I may just actually explain insulin resistance.
Eloise Edington
Yeah, please do. Let’s go back a step and do that because actually that will help to put it together.
Dr. Shivanthy Sivasothy
When we think of insulin resistance, it’s coming down to our glucose metabolism. Glucose is one of the biggest fuels — it is the biggest fuel — for the cells in our body. And insulin is the hormone that carries glucose from our bloodstream into those cells. So when our cells get a bit overloaded or they’re full, they’ve got more than they need to make energy, they don’t — they’re not using it enough — they shut their doors to insulin and glucose.
You quite often see subtle signs before you would see a rise in your blood sugar. The point at which you’ve got a rise in your blood sugar is actually fairly late in the journey of insulin resistance. Some of the first cells to shut their doors are your muscle cells, so you will often feel fatigue as one of the first symptoms — and lethargy and weakness.
One of the next very glucose-hungry organs in the body is your liver. But once it’s full, and once its storage capacity is full, it shuts down, and then we get this disruption in glucose metabolism. We get this disruption in fat metabolism as well, so we start to gain weight, change shape, and we start to put fat on our organs, which majorly disrupts metabolism in the body.
The third organ that’s quite hungry for glucose is your brain. So once the brain cells have shut themselves to glucose, you quite often get this mis-signalling. Early symptoms of insulin resistance can be cravings and feeling hungry all the time. Once again, very vague symptoms, but the point at which you have diabetes or pre-diabetes is really quite late on in this journey.
When we’re thinking of this in terms of PCOS or infertility, the insulin itself — raised insulin in the body — causes a disruption to our sex hormone production. We get an increase in testosterone production, a decrease in progesterone and oestrogen. So it can really affect our periods, our cycle, our fertility.
Managing this starts much earlier than that chronic rise. It’s actually spikes and dips. So if we’re having really big sugar bursts at regular intervals, we’re starting to create these changes in the system in the body that lead to the symptoms of insulin resistance.
Eloise Edington
Interesting. So do you see many people who might be struggling with PCOS, for example?
Dr. Shivanthy Sivasothy
I’ve seen a few people in relation to PCOS, but actually it has generally not just been PCOS. It might be that there have been either concerns around fertility, concerns around perimenopause, menopause, and young girls that are just struggling with their periods and balance really.
Eloise Edington
Really useful to know. And then what about for people who feel they need attention but they haven’t had a diagnosis yet? What would your message to them be?
Dr. Shivanthy Sivasothy
Yes. I think we might be the service for you. One of our key fundamental principles at the Ü Clinic is that we do take time with our clients. I take time to listen and work with our clients to look at these root causes. Then we can look at investigations. It might be a detailed blood analysis. We’ve got access to various forms of technology. Quite often, we’ve used continuous glucose monitors to help us with people when we’re looking at metabolism in particular.
Creating that health plan is so much about understanding your client. I hate the word “prescription” because I don’t really think of it as that. I think of it as a joint plan. Our clients are going on this journey, and they can come to us at any point on that journey for support or coaching.
Eloise Edington
Amazing. And that’s something that The Ü Clinic shines at — this personalised approach. So I want to hear a little bit more about personalised plans. Could you let us know how you do this case by case, spending this time to understand people’s needs and where their focuses need to be? For someone who’s struggling, for example, with irregular cycles or fatigue but hasn’t had any luck with conventional solutions, what would you do?
Dr. Shivanthy Sivasothy
One of the things, as I said, is the first thing — the initial consultation — is about getting to know that person, looking at them and listening to them and their full medical history. When we’re looking at their medical history, we’re looking at their lifestyle history as well. I go back through childhood, detailing periods, cycle changes, but also other illnesses. If they’ve had to have recurrent courses of antibiotics at certain times, if they’ve been under stress, if there’ve been any life events — we really look into the detail of their medical and lifestyle history.
Then we will establish whether we need to do any testing. We work with biomarkers at The Ü Clinic, so we will look at what the levels are now, what we might be trying to achieve, and if there is any imbalance. And as I said, what’s within the normal range of laboratory markers — we’re not always looking at that. Sometimes we’re looking at if people are on the borderline, if it’s not matching with what their history is. We really look at it with a personal approach.
Then, in terms of that plan, it may involve a prescription — a medical prescription — and that’s pending the situation. It depends on what we find and what comes up as to what may be beneficial. For someone with PCOS, for example, we would discuss and explore medications like metformin if we’re working with insulin resistance and issues around weight gain and worsening PCOS as a result of it. I can support with that. I can support with a weight loss journey. So we do look at a medical prescription if it’s necessary.
But our real focus is a lifestyle prescription. One of the unique things that we do is work collaboratively as a team. I actually work very closely with the Ü Clinic’s nutritional therapist. Her name’s Cat Brightite — she’s wonderful — and we work together to look at biomarkers, optimise a nutrition plan. When we’re exploring exercise with patients, we really understand what their baseline is, where they want to go from there, what we’re trying to achieve — and apply that approach to all six pillars of lifestyle medicine.
Eloise Edington
Yeah. Well, it speaks to so many. And for people interested, tell us more about where you’re located.
Dr. Shivanthy Sivasothy
Okay. Thank you. We’re based in Oxford and Surrey, and we’re soon to be opening our second clinic in Sevenoaks in Kent.
Eloise Edington
Congratulations. When’s that?
Dr. Shivanthy Sivasothy
We’re hoping in the summer — in the next month. We’re hoping, just final building work.
Eloise Edington
Great. Brilliant stuff. And then just going back to stress, because we all — especially in the throes of fertility — chronic stress, low-grade stress in the hormone and metabolic picture. How can you help clients tackle the stress?
Dr. Shivanthy Sivasothy
I think stress is so important. It’s really that notorious hidden culprit because we can quite often find ways to say, “No, we’re not stressed — we’re just juggling.” That’s one of my favourite words, particularly as a mom or as a young woman that might be juggling many things in their life. It’s often another word for: there is a chronic stress that’s happening there.
With stress, what we know is that it definitely influences metabolism, but also influences hormones — in particular progesterone, which is a really under-discussed hormone. The focus is always on oestrogen, not progesterone. And so when our cortisol levels are chronically high, the body wants to focus on making cortisol, so it actually reduces the production of progesterone.
Eloise Edington
Yeah.
And particularly at certain times of our cycle, if we’ve not got that progesterone rise, we lose that calming phase of our cycle. So we can become more anxious — mood swings, mood changes — you get the irregularities in your cycle. If you don’t get the rise, you don’t get the fall, and you don’t necessarily get the bleed. There’s elements of that. It influences irregularity, it influences fertility. So when we’re looking at managing stress, it’s one of the key areas that we focus on.
We normally will look at root causes of those stresses. So again, exploring in that initial assessment with our clients, we really take time to explore what could be underlying the stresses or the cortisol.
Eloise Edington
Okay.
Dr. Shivanthy Sivasothy
And then following that, again, it’s applying simple tips and tricks that would be something that client felt that they could do. I don’t think it’s any good — and I think it can actually worsen stress levels — if I said, “I think you should go and do some yoga or do some meditation,” and that person sort of shoots me a look of, “Absolutely I can’t meditate, so don’t tell me to do that.” So we will work out together simple things that might help that person. It could be journaling. It could be walking outside in nature. It could be doing something that makes them laugh, because actually, laughter definitely reduces cortisol.
Eloise Edington
Yeah, and I hear you about the juggling part. And also when someone says, “Do this or put this into your routine,” and you think, “I don’t have time.” But you’re right — you almost need to take a step back and then work out priorities to get to your goals by putting a plan in motion with an expert like yourself to have you on the right foot forward.
And then in terms of movement and exercise, that’s another big factor that you’ve touched on. Can you explain how that has such an impact in your hormonal health?
Dr. Shivanthy Sivasothy
Yes, absolutely. So if we think of exercise, I’m going to actually connect it to metabolism and then hormones, and I think that sort of helps.
Eloise Edington
Yeah. Yeah. Yeah.
Dr. Shivanthy Sivasothy
So exercise is so important just in terms of metabolic health. And as I mentioned earlier, your muscles being one of your most glucose-hungry cells — an active muscle is actually excellent at burning glucose and improving insulin sensitivity. Ultimately, if we’re improving insulin sensitivity, our hormone balance is — our hormones are much better in sync because they rely on that glucose metabolism to be functioning properly.
But when we think about exercise, it’s about striking a balance, isn’t it? Quite often people will say, “Oh,” but you know — they get worried about burnout with exercise. And actually it’s difficult because really, what is burnout? When we’re exercising, we need our blood pressure to go up, we need our pulse rate to go up, and sometimes you do need to be out of breath. Actually achieving something called your VO2 max, where you’re exercising at your maximum oxygen capacity, is actually good for us.
But equally, if it’s causing us immense amounts of stress and pushing up our cortisol, it’s going to poorly impact our hormones. One of the things I think about with exercise and hormones — and this is something that I often talk to young girls, teens about when we’re talking about just trying to get that balance right as their periods are sometimes a bit irregular at the start — is actually learning to exercise with your hormones.
So, progesterone — that very calming hormone — it works on the calming receptors in our brain, actually, so it’s really important to nurture. That might be the end part of your cycle. So maybe about a week or two — a week to ten days before your period — that might be the time to think about calming down with the exercise. Maybe don’t exercise daily, or avoid HIIT, or avoid anything too strenuous, and maybe think more around Pilates or yoga, walking, swimming — just things where you feel that it supports the calmness.
Actually, oestrogen — which is a very, very forgiving hormone and allows for you to push your body — which is the first part of your cycle, also from the first day of your period, is a really good time to exercise a little bit harder. Try to get yourself out of breath. Try and push that pulse rate up.
Eloise Edington
Fantastic. Well, thank you so much for explaining that and also touching on it for fertility. Also, too much exercise can negatively impact your fertility, can’t it? So again, it’s striking that balance between being healthy but not taking it too far.
Dr. Shivanthy Sivasothy
Exactly. So when thinking about it from a fertility perspective, I think — much like I advise those younger teens, because of the irregular periods and the trying to, kind of, you want your ovulation to peak at a certain point — I do think there’s something to be said for changing up the exercise, changing what you do for various points of your cycle. First half, go hard. Second half, less.
Eloise Edington
I love that advice. And then moving on to sleep. We’ve touched on this. I’m someone who’s personally struggled with insomnia for different reasons during my life, and the more I feel it coming back, the more it stresses me out. And obviously, again, you want sleep for hormonal balance — but also, especially when you’re trying to conceive. And the stress of worrying that you might be suffering from insomnia makes it worse. So, absolutely. How do you help your clients with sleep patterns? And have you seen any shifts — where you’ve had positive stories with clients you’ve worked with where it’s improved?
Dr. Shivanthy Sivasothy
Yes. So actually, we look at sleep, and I think we have made — there’s a couple of clients that we’ve helped — actually somebody who’s very elderly — that we made quite a significant sort of difference to, I think, just in terms of helping with sleep. And it’s very hard, particularly as you get older. Your sort of internal body clock, your sleep clock, doesn’t work as well as we get older. So sometimes trying to fight that just actually makes the issue worse. So what we do is we try to optimise the other bits in order to optimise sleep, rather than trying to think about how do I sleep to optimise the other bits.
Eloise Edington
Yes. Exactly.
Dr. Shivanthy Sivasothy
So if I can go back to insulin resistance — melatonin is our sleep hormone. It doesn’t actually send the body to sleep, but what it does is it signals the body, sends messages to the body. It’s another hormone, so it sends messages to the body to switch the sleep processes on.
Eloise Edington
Right
Dr. Shivanthy Sivasothy
So it’s what’s supposed to get you to calm down and get ready to go to bed, but doesn’t make you just fall asleep. And it’s really closely connected to light. So we build our own melatonin store internally through exposure to daylight during the day. And there is a cap to it. So actually early morning sunshine, or morning sunshine, is really, really good for building up that melatonin store. And then in the evening, as the sun goes down, melatonin gets released into your bloodstream. So if you’ve got a healthy amount, then you’ll have a healthy amount in the bloodstream.
Things that block that: cortisol. So again, it’s really important — and what’s shifted and changed for a lot of us — is just changes in habits like working from home, emails, and phone messages, social media, and being on it late. And if any of those signal or trigger stress and cortisol, we will block that release of melatonin or reduce the release and impact of the melatonin.
Eloise Edington
Right
Dr. Shivanthy Sivasothy
And then another thing is around our glucose metabolism — and how well we will then sleep and how we then metabolize the glucose the next day and our hormones — is actually around insulin resistance. There are studies and evidence that say after the sun has gone down, once the melatonin levels are high in our bloodstream, if glucose is also present in the bloodstream, we intensify insulin resistance. So we can exacerbate the problem.
Eloise Edington
Okay. Interesting.
Dr. Shivanthy Sivasothy
But the reverse is: if you have not got glucose, so you’re fasting in that time —
Eloise Edington
Yeah.
Dr. Shivanthy Sivasothy
— actually, you really support your pancreas and you improve insulin sensitivity. So you work towards reversing the resistance. So when women come to me — it’s usually women, a few men have come to me, but the fasting rules are a bit different — and ask me about fasting, I’m not a huge advocate of long fasting. And I think it’s variable for different people as to what suits them. But one thing that I will often advise is that you can look at maybe trying to eat your dinner, eat your main meal, before the sun sets. A little bit harder in winter, but before the sun sets.
Eloise Edington
That’s good advice. Interesting. And we’ve actually got a question about supplements — magnesium supplements for sleep. Do you ever recommend them? Because I took melatonin when I was going through my IVF previous cycle.
Dr. Shivanthy Sivasothy
Yes. So actually — and this is where I work with Cat, our nutritional therapist — one of her areas of expertise and one of the things she contributes to the health plans is supplements and what would be beneficial to people. Something that we often advise — we usually test magnesium levels as well — but we often advise magnesium for sleep.
Eloise Edington
Yeah, magnesium. Good to know. And then of course gut health, which is important for every life stage, but especially for fertility too. So tell us a little bit about how that can impact your hormones and everything we’ve been discussing today really.
Dr. Shivanthy Sivasothy
Yes. I mean, I feel like it’s a whole other subject. Gut health is huge. It in itself — when you think of the gut and the gut microbiome — it’s like a whole body of its own in there. A whole world of interactions that are going on and really underappreciated as a system. But what we’re knowing and getting to know with advancing technology and advancements in testing that can be done to explore gut health, is it is hugely connected to your mind, your brain health, your hormone health, and your metabolic health.
I mean, for one, when we think of the weight loss injections and some of the receptors that those are working on — that is impacting your gut health as well. Or your gut health influences that. But when it comes to hormones — I just don’t even really know where to start other than to say: quite often when we look at root causes of issues, we often find the gut at some point has had a little bit of a hard time.
Eloise Edington
Yeah, I’m sure. I’m sure. And finally, two or three pointers that you would give to people who want to learn more and improve their metabolic health?
Dr. Shivanthy Sivasothy
I mean, our three tips — you mentioned, I felt like you mentioned them earlier — but it’s the three tips that I say to everyone.
The first one is prioritising your health. I think it’s just — it’s difficult. I think when you’re very busy, and if you’ve got families that you’re looking after, if you’ve got relatives that are elderly that you’re looking after, if you’re juggling a job at the same time — high-pressure job, working all hours — it’s very difficult. But prioritising your health is the first step.
And then setting that goal. Setting goals for what you want to achieve with your health.
I think then it’s about understanding your baseline. So before you’re understanding where you’re at now, it’s: what are your biomarkers? So we really work with those — with your blood tests, your blood pressure. It’s really important to know what your baseline is so that if there are subtle changes, you can pick those up early. We don’t want to wait for there to be a really major problem — a diagnosis like diabetes.
Eloise Edington
Yeah. Absolutely.
You know, ten years before that, things can be picked up and changes can be made. Prevention.
And then the third thing is — I’m part of something called the British Society of Lifestyle Medicine — and they have a slogan that I really like to use, which is “One Change.” And it basically means: look at, for example, those six key pillars of your life and have a think about whether you feel that everything — if there are a few things that are off-kilter or that you could improve — pick one and focus on changing it. And once it’s become a habit and you don’t have to think about it anymore, then you move on to the next one.
And it’s a really good way of changing your habits for the better for the long term.
Eloise Edington
Love that advice.
It’s brilliant. Thank you so much, Dr. Shiv. And for anyone who is looking for a personalised health plan and wants some answers or wants to just take control of the situation, I urge you to get in touch with Dr. Shiv and the team at The Ü Clinic for a personalised approach. This is linked up in our bio, so please head there to find out more. I really appreciate your time today. I’ve learned a lot myself.
Dr. Shivanthy Sivasothy
Thank you. Thank you so much for having me.
Eloise Edington
We can’t wait to hear more about the new clinic launch in the next month as well. Very exciting. And, thank you for your expertise today!
Wish you all the best.
Bye!
