Weight Loss Drugs, Pregnancy Risks, Fertility Benefits

The latest buzz about weight-loss drugs focuses on their impact on fertility and pregnancy, with the phrase “Ozempic babies” trending on social media.

Type 2 diabetes treatments such as Ozempic and Mounjaro come with weight loss as a side effect. There are versions of those drugs — Wegovy and Zepbound — approved for people with obesity.

Now, some women taking those medications are reporting getting unexpectedly pregnant — despite fertility issues or, in some cases, while on birth control pills.

Deb Oliviara, a 32-year-old Michigan mother of two, who started taking Ozempic in November 2023 to lose 20 pounds is now pregnant despite previous fertility problems. She says her birth control usage was inconsistent.

“It’s very welcome,” she told TODAY about her pregnancy in a segment that aired on March 27, 2024. “It may have been a shock and not at all in our plans, but we’re open to it.”

When women unexpectedly conceive while taking weight-loss drugs, there are two potential explanations, said NBC News medical contributor Dr. Tara Narula during the segment.

First, having obesity or polycystic ovary syndrome can decrease fertility, she noted.

“So by taking these drugs and inducing a weight loss, you’re potentially regulating the menstrual cycle and ovulation, and improving fertility,” Narula said.

Second, these medications slow down stomach emptying, which can change the absorption of oral contraceptive pills, she added. The same can happen with vomiting or diarrhea, which are common side effects of the weight-loss drugs.

“So you may not be getting as effective amounts of your birth control pills, which could cause a pregnancy that may be not intended,” Narula said.

The prescribing information for Mounjaro and Zepbound advises that patients on those drugs who use oral hormonal contraceptives should switch to a non-oral contraceptive method, or add a barrier method, such as a condom or diaphragm.

Weight-loss drugs are not fertility drugs, and women should immediately stop taking them if they become pregnant, Narula cautioned.

Ozempic and PCOS

After Wynter Mitchell endured three back-to-back unsuccessful pregnancies, her doctor advised her to look into in vitro fertilization. But she noticed the IVF specialists always focused on her weight.

They considered it a “hurdle” to the procedure, says Mitchell, who had a body mass index of 40 at that point, which is sometimes categorized as severe obesity.

She’s had polycystic ovary syndrome since she was a teenager and always had issues with her weight, she explains.

Women with PCOS have a hormonal imbalance and metabolism problems, with symptoms that include weight gain or difficulty losing weight, according to the Office on Women’s Health.

Wynter Mitchell
Wynter Mitchell shares a happy moment with her husband, Allan.Courtesy Wynter Mitchell

When the pounds wouldn’t come off despite working out and eating well, Mitchell shared her frustrations in a Facebook group for women trying to conceive. Someone suggested Ozempic.

Mitchell, who has insulin resistance because of PCOS, says she had no problems getting a prescription. She started taking Ozempic in July of 2022.

“Within a month, I dropped 20 pounds and it was marvelous. I couldn’t believe it. I hadn’t lost that much weight since I was in my mid-30s. I just said, this is a way forward. This is going to get me to the finish line,” Mitchell, 43, a digital strategist who lives in Los Angeles, tells TODAY.com.

“If I got down to a weight that was reasonable for me to be seen, which seemed like it was a BMI of under 35 for all of these specialists, then there would be no question at this point. I would have a successful stimulation and a successful (egg) retrieval, which I ultimately ended up having.”

Wynter Mitchell
Mitchell says she hopes to stay on Ozempic for a year before having the embryo from her IVF procedure placed.Courtesy Wynter Mitchell

Mitchell’s BMI dropped to 33. She has lost 50 pounds so far and wants to continue taking Ozempic until she loses 30 more. She hopes that will put her in the best position when it’s time to place the embryo.

Ozempic and fertility

It’s possible that using medications like Ozempic or Wegovy may improve a woman’s chances of conceiving if she has insulin resistance or obesity, says Dr. Alex Robles, a reproductive endocrinologist at Columbia University Fertility Center in New York.

The drugs themselves don’t boost fertility, but could put a woman’s body into a more optimal state for conception before she tries to get pregnant, he adds.

There’s an association between obesity and infertility, Robles notes. Obese women can have hormonal disruptions that lead to irregular periods — a signal they’re not ovulating regularly. But even modest weight loss can restore the normal hormonal processes that allow ovulation to happen, he says.

It can help with egg retrieval during IVF as well because visualizing and accessing the ovaries in patients who have more body fat can be challenging, Robles explains.

Women with obesity also have significantly higher risk of miscarriage, fetal death and still birth, he says. When the scale doesn’t budge with diet and exercise, he’s noticed some of his patients have been turning to drugs like Ozempic ahead of getting pregnant.

“The best bet is to try to use this medication at least a few months before actually trying to conceive to see if you can achieve the benefit,” Robles says.

On the flip side, he’s seen some data that using Ozempic could potentially negatively impact levels of luteinizing hormone and follicle stimulating hormone — both important for the reproductive system — but that’s likely in the context of rapid excessive weight loss, Robles says.

In a statement to TODAY.com, Novo Nordisk, which makes both Ozempic and Wegovy, says it doesn’t have clinical data evaluating the effect of the drugs on fertility treatments.

Ozempic is not approved for weight management, the pharmaceutical company adds.

“While we recognize that some healthcare providers may be prescribing Ozempic for patients whose goal is to lose weight, we do not promote, suggest, or encourage off-label use of our medicines,” Novo Nordisk says in the statement.

“We trust that healthcare providers are evaluating a patient’s individual needs and determining which medicine is right for that particular patient.”

Can you take Ozempic while pregnant?

Women should stop taking Ozempic and Wegovy at least two months before a planned pregnancy, according to the prescribing information for both drugs.

That’s how long it could take for the drugs’ active ingredient, semaglutide, to completely clear out of a woman’s system, which is important because doctors don’t know how it affects pregnant patients, Robles says.

There is no such warning on the prescribing information for Mounjaro or Zepbound, which have a different active ingredient, tirzepatide.

Wegovy, Zepbound and Mounjaro may cause fetal harm and should not be taken during pregnancy, according to the drugs’ prescribing information.

Ozempic and Mounjaro should be used during pregnancy only if the potential benefit justifies the potential risk, the prescribing information warns. It notes doctors should consider both the risks of poorly controlled diabetes in pregnancy and the potential risks to the fetus from exposure to the drugs during pregnancy.

About 45% of pregnancies in the U.S. are unintended, according to the Centers for Disease Control and Prevention.

Since many women of childbearing age may be interested in taking weight-loss drugs, some doctors worry this population doesn’t know enough about the potential risks if an unplanned pregnancy were to happen while they’re on the immensely popular medications.

Dr. Manijeh Kamyar, a maternal-fetal medicine specialist and OB-GYN in Las Vegas, Nevada, says patients usually tell her no one has discussed the risks of Ozempic with them.

“I think that that’s a huge gap in the use of this medication, especially when something like this ramps up so quickly,” Kamyar tells TODAY.com.

“My recommendation is: While you’re on this treatment — if your doctor has decided it’s the best for you — you should definitely be on some type of birth control. Because if you accidentally get pregnant while on this, I don’t know what that’s going to mean for your pregnancy… I cannot guarantee the safety of this medication in pregnancy.”

The safety data doesn’t exist in humans right now, both Kamyar and Robles say. It may come after years of people using these medications and accidentally becoming pregnant while on them, they add.

There’s a Wegovy Pregnancy Registry to help doctors understand the safety of weight-loss medication use during pregnancy.

Animal data from pregnant rodents, rabbits and monkeys exposed to semaglutide showed structural abnormalities in fetuses and early pregnancy losses, according to the prescribing information for Ozempic and Wegovy.

According to the prescribing information for Mounjaro and Zepbound, animal data from pregnant rodents and rabbits who were given tirzepatide showed fetal growth reductions and abnormalities,

Besides stopping Ozempic or Wegovy at least two months before a planned pregnancy, both Kamyar and Robles advise women to avoid using the drugs while they’re pregnant or breastfeeding.

“It’s very likely that these medications will be excreted in the breast milk. And again, we just don’t know what the effects of this particular drug are on the fetus or the baby,” Robles says.

There is no data on the presence of semaglutide or tirzepatide in human milk, the effects on the breastfed infant or the effects on milk production, according to the prescribing information for Ozempic, Wegovy, Mounjaro and Zepbound.

If a woman unexpectedly becomes pregnant while taking these drugs, she should tell her doctor as soon as possible, both Kamyar and Robles advise. She and her fetus will likely be monitored more closely than a typical patient, Robles adds.

Not a ‘silver bullet’ for fertility

Medication like Ozempic likely is not the “silver bullet” to help women struggling with fertility get pregnant, but it could be a potential adjunct if a patient has obesity or insulin resistance, Robles says.

Kamyar says the medication could be helpful in those cases, but still recommends making lifestyle changes like diet and exercise first to lose weight that way.

She doesn’t think there’s enough information about how these drugs might affect women of childbearing age and pregnant women.

“Research in this area needs to be expedited and physicians really need to do their due diligence in counseling patients that we do not have this data,” Kamyar says.

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