Ozempic, Mounjaro, Wegovy, and other weight loss drugs have received a lot of attention both in the media and the medical community over the past couple of years. This class of medications, known as GLP-1 receptor agonists, was initially developed for the treatment of Type 2 diabetes; however, their benefits for weight loss has resulted in a sharp increase in popularity in recent months. Because of this, we are seeing higher numbers of women taking these drugs during their reproductive years. You might be wondering about GLP-1 agonist use yourself and how that pertains to TTC (trying to conceive) either now or in the near future. Let’s take a look at what we know.
FERTILITY
If you are overweight and have irregular cycles, a GLP-1 agonist might help! GLP-1 agonist use is associated with improved menstrual cycle regularity and increased fertility rates in women who are obese or overweight AND have polycystic ovarian syndrome (PCOS). These medications can help to improve insulin sensitivity in these women, thus resulting in more regular, ovulatory, menstrual cycles an increased fertility. For years we have known that Metformin, another medication used to treat Type 2 diabetes, has similar benefits in the same patient population. GLP-1 agonists also show promise for male fertility in men who are obese and have insulin resistance.
Currently, we recommend discontinuing GLP-1 agonists at least 4 weeks PRIOR to TTC, though 2 months prior is ideal. With that in mind, data regarding fertility with these medications is promising and we may see changes to practice recommendations as more data becomes available.
Thus, a woman with PCOS and/or who is overweight, with or without irregular menstrual cycles, could use a GLP-1 agonist to assist with weight loss PRIOR to TTC. Her menstrual cycles would become regular and ovulatory, and she could then discontinue the medication 8 weeks prior to TTC. It would be important for her to maintain her healthy weight through nutrition and exercise to promote continued, regular ovulatory menstrual cycles and reduce pregnancy risks.
PREGNANCY
The use of GLP-1 receptor agonists is NOT recommended during pregnancy. If you conceive while taking one of these medications, we recommend that you discontinue taking it. HOWEVER, the first large study of GLP-1 receptor agonists was published in December 2023 in JAMA (Journal of the American Medical Association). The results are preliminary, but reassuring, and show no increased risk for major birth defects compared with exposure to insulin alone during early pregnancy.
It is important to understand that diabetes during pregnancy itself is associated with an increased risk for fetal malformations, with around 8-12% of diabetic pregnancies affected. Poorly controlled diabetes is associated with even higher risks. The findings of this study are exciting, but because the number of pregnancies studied was relatively small, more research is needed to confirm that these drugs are not teratogens.
TL;DR
- Ozempic, Mounjaro, and Wegovy are all part of a class of weight loss drugs called GLP-1 receptor agonists.
- GLP-1 receptor agonists promote regular menstrual cycles and can improve fertility in overweight and obese women with PCOS.
- These medications should be discontinued a minimum of 4 weeks prior to TTC, but 8 weeks is ideal.
- Weight loss medication may be a good option for short term use to help with weight loss PRIOR to TTC when timed appropriately.
- More data is needed to fully assess GLP-1 receptor agonists’ safety during pregnancy, but initial studies are promising.
- *Kamm McKenzie OBGYN does not currently prescribe or manage GLP-1 agonists.
Written by Erica Stephenson, MSN, WHNP-BC
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2812743
