Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
We’ve heard a lot about the impacts of Ozempic recently, from rapid weight loss and lowered blood pressure, to persistent vomiting and “Ozempic face”.
Now we’re seeing a rise in stories about “Ozempic babies”, where women who use drugs like Ozempic (semaglutide) report unexpected pregnancies.
But does semaglutide (also sold as Wegovy) improve fertility? And if so, how? Here’s what we know so far.
Remind me, what is Ozempic?
Ozempic and related drugs (glucagon-like peptide-1 receptor agonists or GLP-1-RAs) were developed to help control blood glucose levels in people with type 2 diabetes.
But the reason for Ozempic’s huge popularity worldwide is that it promotes weight loss by slowing stomach emptying and reducing appetite.
Ozempic is prescribed in Australia as a diabetes treatment. It’s not currently approved to treat obesity but some doctors prescribe it “off label” to help people lose weight. Wegovy (a higher dose of semaglutide) is approved for use in Australia to treat obesity but it’s not yet available.
Read more: Ozempic isn't approved for weight loss in Australia. So how are people accessing it?
How does obesity affect fertility?
Obesity affects the fine-tuned hormonal balance that regulates the menstrual cycle.
Women with a body mass index (BMI) above 27 are three times more likely than women in the normal weight range to be unable to conceive because they are less likely to ovulate.
The metabolic conditions of type 2 diabetes and polycystic ovary syndrome (PCOS) are both linked to obesity and fertility difficulties.
Women with type 2 diabetes are more likely than other women to have obesity and to experience fertility difficulties and miscarriage.
Similarly, women with PCOS are more likely to have obesity and trouble conceiving than other women because of hormonal imbalances that cause irregular menstrual cycles.
Read more: I have PCOS and I want to have a baby, what do I need to know?
In men, obesity, diabetes and metabolic syndrome (a cluster of conditions that increase the risk of heart disease and stroke) have negative effects on fertility.
Low testosterone levels caused by obesity or type 2 diabetes can affect the quality of sperm.
So how might Ozempic affect fertility?
Weight loss is recommended for people with obesity to reduce the risk of health problems. As weight loss can improve menstrual irregularities, it may also increase the chance of pregnancy in women with obesity.
This is why weight loss and metabolic improvement are the most likely reasons why women who use Ozempic report unexpected pregnancies.
But unexpected pregnancies have also been reported by women who use Ozempic and the contraceptive pill. This has led some experts to suggest that some GLP-1-RAs might affect the absorption of the pill and make it less effective. However, it’s uncertain whether there is a connection between Ozempic and contraceptive failure.
In men with type 2 diabetes, obesity and low testosterone, drugs like Ozempic have shown promising results for weight loss and increasing testosterone levels.
Avoid Ozempic if you’re trying to conceive
It’s unclear if semaglutide can be harmful in pregnancy. But data from animal studies suggest it should not be used in pregnancy due to potential risks of fetal abnormalities.
That’s why the Therapeutic Goods Administration recommends women of childbearing potential use contraception when taking semaglutide.
Similarly, PCOS guidelines state health professionals should ensure women with PCOS who use Ozempic have effective contraception.
Guidelines recommended stopping semaglutide at least two months before planning pregnancy.
For women who use Ozempic to manage diabetes, it’s important to seek advice on other options to control blood glucose levels when trying for pregnancy.
What if you get pregnant while taking Ozempic?
For those who conceive while using Ozempic, deciding what to do can be difficult. This decision may be even more complicated considering the unknown potential effects of the drug on the fetus.
While there is little scientific data available, the findings of an observational study of pregnant women with type 2 diabetes who were on diabetes medication, including GLP-1-RAs, are reassuring. This study did not indicate a large increased risk of major congenital malformations in the babies born.
Women considering or currently using semaglutide before, during, or after pregnancy should consult with a health provider about how to best manage their condition.
When pregnancies are planned, women can take steps to improve their baby’s health, such as taking folic acid before conception to reduce the risk of neural tube defects, and stopping smoking and consuming alcohol.
While unexpected pregnancies and “Ozempic babies” may be welcomed, their mothers have not had the opportunity to take these steps and give them the best start in life.
Read the other articles in The Conversation’s Ozempic series here.