- There currently is not a lot of research on the effects weight loss drugs like Ozempic and Wegovy may have on fertility.
- Health experts encourage people who are considering conceiving to discontinue such medications at least two months before trying to get pregnant.
- Before making any decisions to stop medications, experts say it’s best to speak with the healthcare provider who prescribed it to you.
Living at a healthy weight can help when trying to get pregnant.
“All the organs that are responsible for producing the hormones necessary for your body to grow an egg, ovulate the egg, and then actually get a period, these things can be disrupted by both extremes of weight,” Dr. Alex Robles, a fertility expert at Columbia University Fertility Center, told Healthline.
When people are underweight, their bodies may stop producing estrogen, and in turn, they may stop ovulating and having regular periods. Ovulation is needed for an egg to be fertilized by sperm.
“The body has a stress mechanism so it can shut off anything that is not essential and unfortunately the body sees fertility as not essential at times of high stress and starvation,” said Robles.
In people who are living with obesity or overweight, hormone levels may also be disrupted due to the increase in body fat levels, preventing them from ovulating.
“There is a lot of data that points to an association between obesity and infertility, particularly if there is an ovulation disorder,” said Robles.
However, even a small amount of weight loss can restore hormones needed for ovulation, as well as reduce the risk of miscarriage and other pregnancy-related complications, he noted.
In fact, the American College of Obstetricians and Gynecologists states that obesity during pregnancy puts a person at risk for the following:
- Gestational hypertension, high blood pressure that begins during the second half of pregnancy.
- Preeclampsia, gestational hypertension, which can cause the kidneys and liver to fail, as well as growth problems for the fetus.
- Gestational diabetes, high levels of blood sugar during pregnancy that can increase the risk of having a large baby and cesarean birth.
- Obstructive sleep apnea can cause fatigue and increase a pregnant person’s risk of high blood pressure, preeclampsia, and heart and lung issues.
Due to the popularity of glucagon-like peptide-1 (GLP-1) receptor agonist medications like Ozempic and Wegovy, Robles is seeing more patients on these medications.
“I’ve seen a handful of patients on these medications already and they are not on them for fertility, but for weight regulation and some of them have metabolic abnormalities as in poor blood sugar control, so they’re on them for that reason as well,” he said.
GLP-1 agonists are FDA approved for type 2 diabetes and Wegovy is FDA-approved for weight management.
There currently is not a lot of research on the effects weight loss drugs like Ozempic and Wegovy may have on fertility. Because of this, Robles said people who are considering conceiving should discontinue the medication at least a couple of months before trying to get pregnant.
Dr. Sethu Reddy, president of the American Association of Clinical Endocrinology, agreed. He said none of the GLP-1 receptor agonists are indicated for improving fertility, and if a person conceives while taking a GLP-1 receptor agonist, they should stop taking the medication.
“We do not have a lot of research evidence to support the continued use of these agents while pregnant. They are given Category C for use in pregnancy meaning that ‘Risk can not be ruled out,’” Reddy told Healthline.
Robles said that patients who see him for fertility evaluation are often hoping to get pregnant as quickly as possible. However, he said it’s important to take time to stop medications that may be unsafe to continue taking during the fertility process.
“There is going to be a delay because there is work up involved, where we need to do a lot of testing and determine what is the best treatment options for the patient, so around that time is a good time to inform the patient that it’s a good idea to discontinue soon as they try to conceive in the next couple of months or so,” he said.
The decision to stop medication for the sake of conceiving isn’t always easy, though. While there are certain medications doctors know are safe to continue during pregnancy like asthmatic inhalers and other medications they know are unsafe like lithium used to treat bipolar disorder, Robles said some medications fall into a grey area.
“[For these medications], animal studies show [one thing], but we don’t see it in human studies yet, and the answer is really we don’t know and in that case, speak to your provider and try to weigh the risks and benefits of staying on a medication versus discontinuing it,” he said.
If it’s medication the patient needs to maintain health, such as their blood pressure or blood sugar, then the provider and patient together may decide that it’s healthier to stay on it for the patient’s sake and accept the risks that are possible with the pregnancy or they may decide it is best to discontinue.
“It’s very difficult for all parties involved,” said Robles. “As a fertility provider, we’re taking care of a patient from a very unique angle, and from a very specific angle and the nice thing is we will often collaborate with a lot of the patients’ other providers to try to get a multi-disciplinary approach to get the patient their own individualized care.”
Reddy stressed that people should consult with their endocrinologist or primary care physician about starting or stopping GLP-1 therapy before pregnancy.
Robles agreed. The doctor who prescribed the medication is best to consult especially if the medication was prescribed for insulin resistance or blood sugar control.
“That particular endocrinologist or primary care physician is going to be the best person to help the patient ween off the medication,” said Robles. “From the fertility standpoint, we can provide guidance to where the patient is in their treatment plan and when we think the patient will be ready to try to conceive by to help with the timing of the discontinuation.”
While weight loss for those who living with obesity or overweight, or have polycystic ovary syndrome, may help in improving fertility, Reddy said weight loss could occur from lifestyle changes.
However, when Robles has a patient who is having difficulty conceiving, he said their age determines whether not weight loss is the first intervention.
“The reason I say young enough is, oftentimes, there can be patients who are seeking fertility treatment who might not have a lot of time. These are patients who are sometimes in their late 30s or early 40s and in which case we know that the reproductive window is quickly closing in,” he said.
Because weight loss can take several months when approached in a healthy manner, there might not be enough time to impact fertility potential.
If a patient is in their late 20s or early 30s, Robles said a trial of weight loss is reasonable in order to try to restore hormonal levels needed to become pregnant.
In this case, when time allows, he recommends dietary changes as the best way to lose weight.
“Based off of the literature, there is pretty clear and consistent data that dietary intervention is going to be the most effective form of weight loss,” he said.
While many people jump into exercise to lose weight, he added that while exercise is beneficial, it’s not as effective as diet when it comes to losing weight.
For people who may have lost weight on medications like Ozempic and then stop taking them when they try to conceive, Robles warned that they may regain the weight because in order to maintain weight loss, the medication needs to be taken.
He suggested talking with your doctor about having a nutrition plan and exercise regimen in place while you take the medication so that you have healthy lifestyle habits to lean on when you no longer take it.
“Ozempic isn’t a magic bullet. Patients who discontinue it often revert back to previous weight, so understanding that and doing the tried-and-true methods of lifestyle intervention [is best],” he said.
