There are a new group of medications being used to treat diabetes and help people lose
weight. Are these medications you should use if you have infertility or are trying to get
pregnant? Are they effective? What are the risks? What does the science say? Stay tuned
There have been
a number of celebrities who have admitted to using a new group of medications for weight
loss. These medications are referred to as GLP-1 agonists. Some well known
brands include medications you have probably seen advertised such as Ozempic, Trulicity,
Rybelsus and Mounjaro. These drugs have a number of different effects in the body that make
them potentially useful for weight loss and for controlling blood sugar in people with diabetes.
I should point out that, in the United States, these medications are currently
only FDA approved for the treatment of diabetes. However, doctors in the US
are allowed to prescribe approved medications for other reasons. This is known as off label
prescribing. This is a pretty common practice. Chances are that in the past your doctor may
have prescribed a medication for you that was off label and you didn't realize it.
As you probably know, if you are a subscriber to this channel, couples who are very overweight have
more difficulty becoming pregnant. Doctors can categorize how overweight people are by looking
at their height and weight and calculating the body mass index or BMI. People with a BMI over
30 in the US are referred to as obese. Recently, a very large study of millions of couples who were
trying to conceive found that when the female partner is obese, there was a 10% reduction in
the number of couples who became pregnant over a year’s time. If both partners were obese,
then their pregnancy rate was reduced by nearly 20%!! I talk about that study in this video.
Studies have found that these new medications may help people lose anywhere from 10 to 30
pounds. This is a pretty decent amount of weight loss. For example, the average
height for a female in the United States is about 5’4”. If we use a weight of 200 pounds,
that would give a BMI of 34 which is well into the obese range. If she was able to lose 30 pounds,
the BMI would drop to 29 which is now in the overweight range. In other words, no longer obese.
Does weight loss actually improve fertility? It seems likely that it does. This review looked
at a number of high quality studies using more traditional methods for weight loss,
diet and exercise, and found that fertility does improve. Is there a
similar benefit if weight loss occurs when using these medications? Well,
we don’t know for sure since those studies have not yet been done. It seems logical.
Weight loss is weight loss no matter how you got there, right? Maybe, but we just don’t know.
There is another issue to consider. We don't yet have a good understanding about whether
these medications may cause birth defects. As a result, some of the pharmaceutical companies
that make these medications recommend that women stop taking these medications at least two months
before attempting pregnancy. However, studies have shown that once these medications are stopped,
people start to regain weight pretty quickly. So even though these medications may be an
effective weight loss treatment, they might not be the best choice for someone who is looking to
conceive unless they can keep the weight off for several months after stopping the medications.
Another group of patients who might benefit from GLP-1 agonists are people with polycystic ovary
syndrome also known as PCOS. Many, though not all, people with PCOS are obese. Many people
with PCOS also have resistance to the hormone insulin which is the same problem which causes
Type 2 diabetes. Because of these two factors, scientists have been anxious to study whether
these medications might be an effective treatment for PCOS. A long established medication called
metformin is commonly used to treat people with diabetes due to insulin resistance and
PCOS and has been shown to improve the chance for ovulation and pregnancy in PCOS patients.
There have been several studies in which PCOS patients were treated with these medications.
There is consistent evidence that certain blood tests show improvement and some evidence that
irregular cycles tend to be more regular. While this is very encouraging, there hasn’t been,
as of yet, any studies which show that the chance for pregnancy is higher. When we do
have those studies, you can be sure that I will discuss them here on InfertilityTV.
Our Infertility TV Bottom line is this. If you are obese and have been unable to lose weight
with diet and exercise, GLP-1 agonists may be a helpful tool for you. If you have PCOS, GLP1
agonists may help improve some of the metabolic problems that we see in PCOS. It might be worth
a try especially if you were unable to tolerate metformin. If you are trying to conceive, be
cautious. All we have right now are indirect hints that these medications might improve fertility in
people with obesity or PCOS and we don’t know the impact it might have on a developing fetus.