What is the relationship between GLP-1 medications and fertility?
GLP-1 medications taken for weight loss have enjoyed widespread usage since their introduction a few years ago. By one estimate, nearly 1 in 8 American adults have reported using GLP-1s either for weight loss, diabetes management, or another chronic condition. GLP-1s are now being studied and used for other health benefits beyond blood sugar control and weight loss, such as reducing inflammation, treating sleep apnea, and heart disease. With so many possible benefits of this seemingly wonder drug, is there also a relationship between GLP-1 medications and fertility?
Women who are overweight may not ovulate regularly
Being overweight or obese can reduce a woman’s fertility by causing menstrual cycles to be irregular or infrequent. Metabolic conditions such as polycystic ovarian syndrome, or PCOS, and insulin resistance reduce ovulation frequency. For obese women, the body’s muscles and fat tissues become resistant to insulin causing the pancreas to produce higher insulin levels than the body needs. These high insulin levels signal the ovaries to produce higher amounts of male hormones (androgens) causing egg follicles to die before they release mature eggs.
Because of the over-production of insulin when you are overweight, your chances of having a baby can drop dramatically when your BMI (body-mass index) is greater than 35. But losing weight can help restore normal insulin levels and a normal menstrual cycle. And when your cycles are normal and ovulation occurs, your fertility improves. Studies have shown that weight loss of just 5% to 10% of your body weight can dramatically improve ovulation and pregnancy rates.
GLP-1 medications have an indirect impact on fertility
GLP-1 medications act on the brain and the body’s hormones to help suppress hunger and slow digestion. Medications like Ozempic, Wegovy, Zepbound and Mounjaro, speed up weight loss thereby improving insulin sensitivity. Better insulin production helps lower androgen levels and restore ovulation in women especially those with PCOS and insulin resistance. Because of these interactions, women taking GLP-1 medications are also seeing an indirect boost to their fertility when their menstrual cycles regulate and release eggs more regularly.
Additionally, GLP-1 medications may impact fertility in a way that many women may not want. Since GLP-1s delay stomach emptying, this affects how food and oral medications, like birth control pills, are absorbed. This can make oral birth control less reliable, especially when first starting the medication or changing doses. If you are on weight loss injections, it is recommended that you also use an alternative form of birth control.
Men can also see a boost in fertility from GLP-1s
Male fertility may also be getting a boost from GLP-1 medications. Obesity in men often reduces testosterone and increases estrogen (yes, men produce estrogen, too!). Emerging studies suggest that weight loss from GLP-1s can help balance testosterone and improve overall sperm quality in men. By promoting weight loss and stabilizing blood sugar, GLP-1s can help reverse obesity-induced low testosterone, leading to enhancements in sperm count, sperm concentration, and sperm motility.
Safety and pregnancy precautions when taking GLP-1 medications
Despite all of the positives that GLP-1s can have on fertility in both men and women, there is still a lot we don’t know. GLP-1 medications are not approved by the FDA as fertility drugs. Further, experts strongly advise not taking GLP-1s during pregnancy because there is insufficient long-term data on how these medications may impact fetal development. Rapid weight loss, nutritional deficiencies and medication exposure of GLP-1s while pregnant could have serious complications for a growing baby.
FDA guidelines currently recommend stopping GLP-1 medications at least two months before trying to conceive. This allows the drug enough time to fully clear your system. If you accidentally become pregnant while taking a GLP-1, you should stop the medication immediately and contact your OB/GYN or a maternal-fetal medicine specialist.
