The Link Between Ozempic and Fertility

Social media users claim they got pregnant while on Ozempic and similar drugs after years of infertility. Doctors say it is not the drug but reduced body weight that can lead to unintended pregnancies.

Ozempic, Mounjaro, and other drugs that belong to a class of medicines called GLP-1 receptor agonists took the world by storm as they can help to lose 10-15% of the body weight, although it may bounce back within the first year of discontinuation.

Initially approved for treating type 2 diabetes, the medications are increasingly used off-label for weight loss. Research has also linked GLP-1 receptor agonists to cardiovascular benefits, lower dementia risks, and reduced symptoms of alcohol use disorder.

Now, TikTok, Facebook, and Reddit users claim they are expecting or just gave birth to "Ozempic babies." Some say they got pregnant despite being on birth control.

The impact of GLP-1s on fertility is likely to be indirect, says Jennifer Kawwass, M.D., who is board-certified in reproductive endocrinology and infertility and a professor at Emory School of Medicine.

"Weight loss and return to a normal body mass index increases the likelihood of cycle regularity and, as a result, the likelihood of conception," Kawwass tells Healthnews.

Currently, there is no sufficient evidence that GLP-1s are safe to use during pregnancy. Animal studies associated these medications with higher rates of miscarriages and bone, kidney, and liver birth defects.

It is noteworthy that the findings in animals do not necessarily translate into humans. Many drugs are not approved for use during pregnancy because including pregnant women in trials is too risky, and there are many ethical considerations to take into account when doing so.

Weight loss improves ovulatory function

Eve Feinberg, M.D., a reproductive endocrinologist at Northwestern Medicine, says inconsistent pill use in combination with improved ovulatory function may explain improved fertility while on GLP-1 receptor agonists.

Many women who are overweight or obese do not ovulate regularly. Their menstrual cycles become more regular with weight loss due to improved pulsatility from the hypothalamic-pituitary axis, a system that regulates stress response.

"With improved pulsatility, there is the better release of gonadotropin-releasing hormone, which stimulates the release of follicle-stimulating hormone and luteinizing hormone, both of which are essential for follicle recruitment and ovulation," Feinberg says.

Women with obesity have a threefold higher risk of infertility than non-obese women, and they need a longer time to get pregnant, including in assisted conception programs, such as in vitro fertilization (IVF).

Ozempic and the effectiveness of the pill

Currently, there is no evidence suggesting that the use of GLP-1s reduces the effectiveness of birth control.

Kawwass does not rule out that the metabolism of the GLP-1 medications could impact the metabolism or the absorption of the oral contraceptive pills, which could impact the efficacy of the contraception.

Mounjaro's drug label states that the drug has the potential to impact the absorption of oral medications due to delayed gastric emptying. The patients on oral hormonal contraceptives are advised to switch to a non-oral contraceptive method or add a barrier method of contraception for four weeks after starting the drug or increasing the dose.

Feinberg says insulin resistance, which is commonly linked to obesity, impacts the hypothalamus, an area in the brain that controls hormone production. Improved insulin sensitivity due to weight loss induced by GLP-1s improves the release of reproductive hormones.

The pill, when taken properly and consistently, should prevent the release of these hormones. There is a possibility that GLP1 agonists may induce liver enzymes that alter the metabolism of oral contraceptive pills, but this has not yet been reported and studied, and with reports of women conceiving on the pill, this should prompt further investigation.

Feinberg

Impacts on pregnancy are yet to be seen

Contraceptive pills are 99% effective at preventing pregnancy if used correctly — taken every single day at the same time of day. Some medications, like the antibiotic Rifampin or certain antiseizure drugs, can reduce the effectiveness of the pill.

Vomiting or having diarrhea — common side effects of GLP-1s — for more than 48 hours can also make the pill less effective.

Interest in GLP-1s is only increasing, and pharmaceutical companies are now developing new drugs like Zepbound specifically for weight loss in patients without diabetes. At the same time, concern grows around their side effects.

The drugs have been found to increase the risk of pancreatitis, stomach paralysis, and bowel obstruction. The drugs have also been linked to rare but severe psychiatric events, such as suicidal ideation.

When it comes to the impact of GLP-1s on pregnancy and the development of babies, it may take years to get a clear picture. Novo Nordisk, the manufacturer of Wegovy, is now conducting research that looks into the drug-related complications in pregnancies that have already happened. The study will be completed in 2027.

However, Ozempic and other GLP-1 agonists are primarily drugs for diabetes, a condition prevalent among women of reproductive age and itself linked to a higher risk of birth defects.

A 2023 study published in the JAMA Internal Medicine that used data from 3.5 million pregnancies suggests that newer diabetes drugs, including GLP-1 agonists, do not increase the risk of birth defects compared to insulin.

The authors said birth defects that occurred in the study population resulted from diabetes rather than medications, although more research is needed to confirm that diabetes patients can safely use GLP-1s during pregnancy.

Ozempic and other GLP-1 agonists may positively impact fertility due to improved insulin sensitivity and weight loss. However, the medications should not replace fertility treatments or be used during pregnancy due to a lack of safety data.