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You asked: Can Ozempic improve fertility?

Women’s health physician answers your questions about increased fertility, birth control efficacy and pregnancy safety while on GLP-1 agonist medications
A person’s hands holding a newborn baby wrapped in a striped hospital blanket and wearing a striped beanie

Many women have shared stories of their “Ozempic babies”—unexpected pregnancies while taking Ozempic or similar medications for diabetes or weight loss. Although this term has taken off across social media, its meaning is not exclusive to Ozempic; any GLP-1 receptor agonist medication, which is the class of drug to which Ozempic belongs, can increase fertility and lead to pregnancy in women of reproductive age.

With the rapid rise in popularity of these medications, women are beginning to question fertility changes, birth control pill reliability, and the safety of pregnancy while using GLP-1 agonists, which are not approved for pregnancy.

Hector Chapa, MD, board-certified OB-GYN, clinical assistant professor and clerkship director for OB-GYN at Texas A&M University School of Medicine, offers his insight to clear up the confusion around “Ozempic babies.”

What is a GLP-1 agonist?

Glucagon-like peptide-1 (GLP-1) receptor agonists are a class of medications that are used primarily for blood sugar control in patients with type 2 diabetes (T2D) but have become increasingly prescribed for weight loss. Name brand GLP-1 agonists approved by the U.S. Food and Drug Administration (FDA) for weight loss include Ozempic, Wegovy and Victoza. A close relative of GLP-1 agonist drugs is tirzepatide, which is marketed as Mounjaro for type 2 diabetes and Zepbound for weight loss.

The function of GLP-1 agonists inhibits glucagon secretion, reduces appetite and delays the rate of gastric emptying in response to food intake. GLP-1 receptor agonists have been shown to improve glycemic control and to provide beneficial reductions in body weight in patients with T2D and in patients with obesity.

What explains the increase in fertility?

Although patients may be experiencing spontaneous ovulation after taking a GLP-1 receptor agonist, it’s not a direct result of the medication—it’s actually due to weight loss. Obesity is a big disruptor of ovulation because insulin levels disrupt the ovaries’ egg release cycle.

“Insulin doesn’t just affect the body overall, it also affects the ovary,” Chapa said.

Chapa describes the link between obesity and ovulation as a kink in the production of eggs released from the ovary, which results in infertility. Obesity’s distinct metabolic profile, marked by insulin resistance, has significant repercussions for reproductive health. Often, those who have polycystic ovarian syndrome (PCOS) also have insulin resistance, which is when your body makes the hormone insulin but can’t use it correctly. “PCOS is not just a gynecological term, it’s a metabolic term,” Chapa said.

Insulin resistance has a direct relationship with hyperinsulinemia—abnormally high levels of insulin in the body—that affects two cells in the ovaries: granulosa cells in small follicles and theca cells. This induces the granulosa cells’ premature response to luteinizing hormones (LH) that trigger the release of an egg from the ovary. As a result, the cells mature before the eggs are ready to be released, inhibiting ovulation. In the theca cells, high levels of insulin contribute to the increased secretion of androgens, which are male hormones. The excess amount of androgen converts to estrogen which elevates LH levels. This results in menstrual disturbances and infertility.

Once a person starts taking weight loss medication and their weight comes down, insulin levels also come down, and the negative effect on the ovaries is released, improving ovulation.

“The short of it is, no system in the body is isolated. Because infertility is in the ovaries and the uterus, what does that have to do with your pancreas? The answer is, everything,” Chapa said.

Do GLP-1 agonists decrease birth control efficacy?

Women of reproductive age who take GLP-1 agonists are highly encouraged to be on birth control since the effects of these medications on pregnancy are still unknown. However, what’s also uncertain is whether GLP-1 agonists affect oral contraception, or birth control pills.

One of the ways these medications contribute to weight loss is their effect on stomach emptying, slowing the time it takes for food to move from the stomach to the gut. This means the oral medication spends less time in the gut, which limits the amount of the medication that is absorbed by the body.

However, limited data states that if oral contraception is taken correctly, there’s no decrease in efficacy, even while taking GLP-1 agonists. The first study to investigate the coadministration of semaglutide, a generic form GLP-1 agonist, concluded that it’s not expected to reduce the efficacy of oral contraceptive medications.

“What makes the headlines is that birth control fails with these medications. However, that may not be entirely true. More data is needed. The limited data that exists, especially regarding oral contraception, is somewhat reassuring,” Chapa said. “Nonetheless, other contraceptive methods that don’t require absorption from the gastrointestinal tract are advised. These can include the arm implant or intrauterine contraceptive options.”

Chapa says cases where women became pregnant while on oral contraception are likely because they either stopped their birth control or did not take it correctly.

Even though semaglutide or other GLP-1 agonists might not affect birth control, there is medicine that is known to make birth control less effective, so it’s important to read the medication label and manufacturer warnings before making assumptions. For any birth control that depends on patients taking it correctly, consistency plays a huge role. Since there’s not currently enough data to support or debunk the reduced effectiveness of oral contraception when used with GLP-1 agonists, it’s best practice to use a backup method such as condoms and spermicide.

“That’s why things that take away compliance, like the implant or the IUDs, according to the American College of Obstetricians and Gynecologists, should always be considered first line, as long as the patient qualifies and desires it,” Chapa said.

Are GLP-1 agonists safe for pregnancy?

The chances that these medications are harmful to pregnancy are very small, but the jury is still out since not enough data has yet been collected. JAMA released reassuring case evidence for safety during pregnancy, but Chapa says it’s critical to always read the medicine label and manufacturer warning. GLP-1 receptor agonists are not approved by the FDA for use during pregnancy.

“Medical labels and peer reviewed data are very different, and sometimes they don’t agree,” Chapa said.

If you’re purposely trying to get pregnant, Chapa recommends having a “wash out” period where medication is stopped for one to three months to give your body enough time to metabolize out all the medication.

If pregnancy does occur, a physician will likely recommend stopping the medication immediately and receiving adequate prenatal care going forward.

What’s the alternative to a GLP-1 agonist?

Medication should not take the place of behavioral or lifestyle modification. Healthy eating and moderate exercise are the gold standard for maintaining an optimal weight. Although GLP-1 agonists have helped many people lose weight, they should only be used as a second-line measure—and they’re not meant to be an indefinite or lifelong solution.

For women who are struggling to become pregnant, getting to a healthier weight should help. However, Chapa says that highly restrictive dieting while pregnant or while trying to become pregnant is not the way to go.

“No one advises dieting in pregnancy because the baby needs extra caloric intake. However, we do recommend a healthy diet—not ‘diet’ as a term of dietary restriction, but healthy eating,” Chapa said.

The Centers for Disease Control and Prevention (CDC) recommends eating healthy and nutrient-based foods during pregnancy and exercising to a level that you are used to.

GLP-1 receptor agonist medications are relatively new on the scene, so long-term human data, particularly in pregnancy, is limited. Women’s concerns for increased fertility, birth control efficacy and unexpected pregnancy while on these medications can be addressed with a health care provider. Although data can provide reassurance, it’s important to exercise caution. Always consult your health care provider and review medication labels and manufacturer warnings to address any uncertainties, especially if you are pregnant, planning pregnancy, or could become pregnant while using GLP-1 agonists or other weight loss medications.

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