Ozempic and Fertility

GLP-1 receptor agonists (RAs), more commonly known as semaglutide and by their brand names Ozempic and Wegovy, have made waves in the healthcare industry. More people with Type II diabetes are taking these medications in hopes to reduce the chances of debilitating diseases and complications such as nonalcoholic fatty liver, heart, and kidney disease.

Although GLP-1 agonists were originally created to help control insulin levels for diabetics, they have been found to help with another deadly condition – obesity. While people take their weekly shot to control glucose and insulin levels, reduce appetite, and control hormones, they sometimes get another surprise benefit from these medications – enhanced fertility.

Key Takeaways

• GLP-1 RAs like Ozempic and Wegovy were developed to control consequences of Type II diabetes, but are increasingly popular for weight loss in the reproductive age group:
• Unexpected Pregnancies Are Happening: Some women with polycystic ovarian syndrome, obesity, and irregular menstrual periods are reporting surprise pregnancies after using GLP-1 RAs.
• Men May Benefit Too: In some cases, these medications may enhance sperm quality in men with obesity.
• Pregnancy Safety Is Unclear: The safety of GLP-1 RAs during pregnancy is not well understood. The FDA recommends discontinuing them at least two months before trying to conceive and not using them while breastfeeding.
• Consult Your Doctor: If you are on GLP-1 RAs and thinking about pregnancy, talk to your healthcare provider about birth control, fertility, and risks and side effects of the medication

How Do GLP-1 RAs Work?

GLP-1 RAs are injectable medications that were originally developed to help treat Type II diabetics by controlling blood sugar levels.. They mimic the hormone in the pancreas that tells the body to create more insulin when blood glucose levels rise, more often than not, from eating. During this hormonal process the brain receives a signal that tells the body to empty the stomach more slowly, which in turn, provides the brain with signals of feeling full longer. Hunger and cravings are diminished, which usually results in weight loss.

The GLP-1 receptor agonist semaglutide is available by prescription as Ozempic or Wegovy. Ozempic is FDA-approved only for the prevention of complications of Type II Diabetes; Wegovy is also approved for the treatment of obesity. However, Ozempic is widely used “off label” for the treatment of obesity. The dose should be determined by your physician.

The Rise of the #OzempicBaby

Women throughout the US have struggled with infertility or low fertility. Many have tried to conceive for years, and heartbreak after heartbreak, have not succeeded. A new trend has started to crop up with some of these women, and other women alike. After taking a GLP-1 agonist as prescribed, they have begun to see an increase in pregnancies thought to be directly related to an increase in fertility from GLP-1 agonists. 

Clinical trials have shown that GLP-1’s have helped women lose 15%-20% of their total body weight. For individuals who have experienced obesity, substantial weight loss can support ovulation, regulate estrogen levels, and promote a more consistent menstrual cycle. This is because it lowers estrogen levels that can result in diminished fertility if levels are too high.

A Rising Concern

While an unanticipated pregnancy can be life changing and exciting for many, they also bring about certain levels of concern.  Women want to know whether or not GLP-1 agonists will affect their baby, especially if they become pregnant while taking one.

Currently there is limited knowledge about the effects of GLP-1 agonists on  the health of pregnancy or fertility in general. Side effects of these medications include nausea, vomiting and diarrhea, which may compromise the mother’s nutritional state in early pregnancy. Over time, the research will grow as popularity and use continues. For now, let’s focus on the facts that we do know about how weight loss drugs might improve fertility for some men and women.

Diabetic Complications and Infertility

Individuals with diabetes often experience difficulties with ovulation. Irregular periods result from complications with ovulation, which makes it harder to get pregnant. Many people who suffer from obesity also suffer from type 2 diabetes. These patients also suffer from a  hormonal imbalance from an increase in estrogen levels due to type 2 diabetes which is a contributing factor to infertility.

Hormonal imbalances, including disruptions in estrogen, are linked to polycystic ovary syndrome (PCOS). This condition affects women by causing symptoms such as weight gain or obesity, infertility, insulin resistance, high testosterone levels, ovarian cysts, excessive facial hair growth, and scalp hair thinning. In the United States, around 7% to 10% of women of childbearing age have PCOS.

GLP-1 RAs May Support Hormonal Balance for Fertility

This is where a GLP-1 RA can become helpful. When an obese woman loses 10% of her body weight, hormone-related symptoms linked to estrogen imbalance may improve.

In the SELECT trial researchers found that 44% of patients taking semaglutide lost more than 10% of their body weight within two years, while 11% lost over 20%—a substantial reduction that can positively impact fertility.

GLP-1 RAs and Male Fertility

Some research suggests that GLP-1 receptor agonists (RAs) may also support male fertility, especially in those with obesity, by enhancing sperm concentration, movement(motility), and shape (morphology).

Because of this, individuals with sperm who use these medications for weight loss or diabetes management should talk to their doctor about fertility, future family planning, and the possibility of unexpected pregnancies.

Are GLP-1 RAs Safe to Use While Pregnant?

Women who have faced fertility challenges may not use birth control regularly or consistently. Those with a history of  irregular periods might not immediately recognize a missed period due to pregnancy. Even women with regular menstrual cycles may not know they are pregnant until six weeks or later.

As a result, a pregnancy could be exposed to GLP-1 RA medications for weeks or even months before detection.

Further research is needed to determine whether weight-loss medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) affect birth control efficacy or are safe during pregnancy. However, clinical studies have historically excluded pregnant women, limiting available data.

Current Research on GLP-1 and Pregnancy

Studies on pregnant animals have shown adverse effects on fetal development, even at doses below what would be recommended for humans. These include miscarriages, structural abnormalities, and abnormal growth. 

A study in 2023 looked at 50,000 pregnant women with Type 2 diabetes. It found that out of 900+ women who were taking GLP-1 RAs when they found out they were pregnant, there was no clear proof that their babies had more birth defects than usual. This is reassuring but not conclusive because of the small sample size and lack of long-term follow-up.

To gather more data, Novo Nordisk, the manufacturer of Ozempic and Wegovy, and Eli Lilly, the maker of Mounjaro and Zepbound, are tracking pregnancy and postpartum health outcomes in women who used these medications at the time of conception.

FDA Guidelines on GLP-1 for Women

Due to limited conclusive evidence, the FDA currently advises stopping GLP-1 RAs at least two months before conception as the medication lingers in the body.

Additionally, GLP-1 RAs should be stopped while breastfeeding, as the drug can transfer into breast milk.

Individuals who had irregular cycles or weight changes before starting GLP-1 RAs may not immediately recognize a pregnancy. It is recommended that those with obesity work closely with both an obesity specialist and an Ob/Gyn before, during, and after pregnancy to reduce risks they will inadvertently take the medication while pregnant and to support a healthy outcome.

The FDA also recommends that all patients on GLP-1 RAs notify their physician if they are planning surgery so that their medication or diet can be adjusted before the surgery. The stomach empties more slowly on GLP-1 RAs and the risk of aspirating stomach contents is increased in surgery.

Optimizing Your Fertility Before Pregnancy

Women with obesity face a higher risk of pregnancy complications, such as preeclampsia (a condition in which a pregnant woman's blood pressure is too high), gestational diabetes, C-section delivery, and pregnancy loss. While some weight gain is normal during pregnancy, those with obesity should work closely with their healthcare provider to ensure healthy weight management.

As GLP-1 RA medications become more popular for weight loss, heart health, and diabetes management, many people have questions about how they may affect fertility. Women who are considering bariatric surgery to improve their health and fertility might benefit from using GLP-1 RA medications instead. 

If your healthcare provider hasn’t brought up the topic, consider initiating the conversation. Understanding the potential effects of these medications can help you make informed decisions about your health and family planning.