Podcast Episode 16: GLP-1s and Fertility
Let’s talk GLP-1s.
In Episode 16 of The Zesty Dietitian Podcast, I dive into a huge topic lately - GLP-1s and fertility. As a weight inclusive dietitian, I have a lot of thoughts, and there's a lot of nuance when it comes to this topic.
We go over what a GLP-1 is and what it does, how it may help with PCOS/PMOS, side effects and nutrition considerations, and how to make the best decision for YOU about whether a GLP-1 is the right step for your reproductive health journey. We also answer a few questions from our listeners about nutrients to test for in labs if you’re on a GLP-1, GLP-1s for PCOS, GLP-1s while breastfeeding, and navigating anxiety about weight gain when coming off a GLP-1 for pregnancy.
Watch Episode 16 on YouTube here
Additional resources:
Blog: GLP-1s and fertility
Blog: Inositol
Dr. Clara Telford (Dallas, TX OBGYN)
Sources:
Barrea, L., Muscogiuri, G., Pugliese, G., de Alteriis, G., Colao, A., & Savastano, S. (2021). Metabolically Healthy Obesity (MHO) vs. Metabolically Unhealthy Obesity (MUO) Phenotypes in PCOS: Association with Endocrine-Metabolic Profile, Adherence to the Mediterranean Diet, and Body Composition. Nutrients, 13(11), 3925. https://doi.org/10.3390/nu13113925
Darwish, R., Abu-Sharia, G., & Butler, A. E. (2025). History of glucagon-like peptide-1 receptor agonists. Pharmacological Research, 222, 108045. https://doi.org/10.1016/j.phrs.2025.108045
Legro, R. S., Hansen, K. R., Diamond, M. P., Steiner, A. Z., Coutifaris, C., Cedars, M. I., Hoeger, K. M., Usadi, R., Johnstone, E. B., Haisenleder, D. J., Wild, R. A., Barnhart, K. T., Mersereau, J., Trussell, J. C., Krawetz, S. A., Kris-Etherton, P. M., Sarwer, D. B., Santoro, N., Eisenberg, E., … Network, for the R. M. (2022). Effects of preconception lifestyle intervention in infertile women with obesity: The FIT-PLESE randomized controlled trial. PLOS Medicine, 19(1), e1003883. https://doi.org/10.1371/journal.pmed.1003883
Maya, J., Pant, D., Fu, Y., James, K., Batlle, C., Hsu, S., Soria-Contreras, D. C., Shook, L. L., Mow, C., Hivert, M.-F., Thaweethai, T., & Powe, C. E. (2025). Gestational Weight Gain and Pregnancy Outcomes After GLP-1 Receptor Agonist Discontinuation. JAMA, 334(24), 2186–2196. https://doi.org/10.1001/jama.2025.20951
Paterson, H., Treharne, G. J., Horwath, C., Haszard, J. J., Herbison, P., & Hay-Smith, E. J. C. (2019). Intuitive eating and gestational weight gain. Eating Behaviors, 34, 101311. https://doi.org/10.1016/j.eatbeh.2019.101311
Quansah, D. Y., Gilbert, L., Gross, J., Horsch, A., & Puder, J. J. (2021). Intuitive eating is associated with improved health indicators at 1-year postpartum in women with gestational diabetes mellitus. Journal of Health Psychology, 26(8), 1168–1184. https://doi.org/10.1177/1359105319869814
Quansah, D. Y., Gross, J., Gilbert, L., Helbling, C., Horsch, A., & Puder, J. J. (2019). Intuitive eating is associated with weight and glucose control during pregnancy and in the early postpartum period in women with gestational diabetes mellitus (GDM): A clinical cohort study. Eating Behaviors, 34, 101304. https://doi.org/10.1016/j.eatbeh.2019.101304
Sola‐Leyva, A., Pathare, A. D. S., Apostolov, A., Aleksejeva, E., Kask, K., Tammiste, T., Ruiz‐Durán, S., Risal, S., Acharya, G., & Salumets, A. (2024). The hidden impact of GLP‐1 receptor agonists on endometrial receptivity and implantation. Acta Obstetricia et Gynecologica Scandinavica, 104(2), 258–266. https://doi.org/10.1111/aogs.15010
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Copyright 2026 Feed Your Zest Nutrition & Wellness, LLC
Podcast music by Myles Maxwell
Transcript
GLP-1s, are all the rage currently, and for many of our clients in larger bodies, they’re being recommended to promote weight loss and improve various aspects of fertility prior to pregnancy. As a registered dietitian specializing in weight inclusive reproductive health, I absolutely have some thoughts on this topic, so let’s dive in!
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This episode is brought to you by our 1:1 nutrition counseling program here at Feed Your Zest. When it comes to reproductive health conditions like endometriosis, PCOS, infertility, and gestational diabetes, it seems like everyone has something to say. Throw in a complex relationship with food and body, and we’ve got a recipe for a crash out. If you’ve ever felt overwhelmed with all the “nutrition tips” out there from your mom, your doctor, and the internet, trust me when I say that you are so not alone, AND you don’t have to navigate all of that alone either!
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First things first, what is a GLP-1? The official name for this class of medications is GLP-1 receptor agonists. While they seem new, they’ve actually been on the market in the US since 2005. As with all scientific discoveries, almost 100 years of research is behind the eventual creation of exenatide, the first GLP-1 to be approved by the FDA, but even more interesting is the fact that exenatide was produced because of a scientist who was researching bioactive compounds found in the venom of a poisonous lizard known as the Gila monster. Crazy right?
So to backtrack, GLP-1 is part of a class of peptide hormones that occur naturally in the human body. It is produced by the gut when carbohydrates are consumed. It stimulates the pancreas to release insulin, the hormone that tells our cells to use glucose for energy. It also keeps the pancreas from releasing glucagon, which is a different hormone that tells our liver to release glucose into the bloodstream. GLP-1 also slows down your digestion, which can increase a sense of satiety.
GLP-1 receptor agonists are drugs that mimic the effects of GLP-1 naturally produced in the body. From here on out, when I say “GLP-1s” or GLP-1 drugs, I’ll be referring to the class of medications vs the natural hormone.
For folks with type 2 diabetes, the discovery of GLP-1 drugs has been revolutionary for blood sugar management. Diabetes is a complex disease, and as an adjunct to nutrition and lifestyle changes, GLP-1s can make a huge difference not only in treatment success, but also in reducing complications like heart disease.
GLP-1s target insulin resistance. If you’re not familiar with what insulin resistance is, let me break that down for you really quick.
Anytime you eat any food containing carbohydrates, whether that’s an apple, a piece of bread, or a soda, your body breaks down those carb molecules into glucose in your digestive tract. Glucose is then absorbed into your bloodstream and used as the body’s primary source of energy.
Think of your bloodstream like a hallway, and glucose as a person walking down the hallway. Off the hallway are all these doors leading to offices which represent your cells. The glucose people need to get into the offices to do their job providing energy, but the doors to the offices are locked. When glucose enters the building (your body), the pancreas senses this and sends out insulin, which acts like a key to open those doors so glucose can do it’s job.
If you have insulin resistance, the locks on the doors are rusty, so glucose can’t get into the offices. The pancreas senses this and thinks “oh shit, we must need more keys!” and sends out MORE insulin. This can get the job done, but this system doesn’t work perfectly, leaving glucose in the hallway too long, which can cause damage to the hallways and ultimately lead to nerve issues or heart disease. Additionally, those high insulin levels can turn on and off other functions in your body, including ovulation and other hormonal symptoms of PCOS like acne and facial hair. High insulin levels can also lead to weight gain or difficulty losing weight, because insulin tells our body to turn glucose into fat instead of using it for energy.
GLP-1s act like WD-40 in those locks to help them work better. This means that the body needs less insulin to make the system work correctly. Other drugs like metformin also can also help those locks work better, as can nutrition and lifestyle changes, and supplements like inositol.
One side effect that was noted in the studies on patients prescribed GLP-1s for their diabetes was weight loss. This results mostly because GLP-1s cause digestion to slow down dramatically, which can lead folks to feel fuller faster, and therefore eat less food. That said, GLP-1s do also improve some hormonal signalling involved with hunger and fullness in folks with insulin resistance, and can help the body need less insulin to unlock those office doors and use glucose for energy like I explained earlier. So, even if someone were to eat a similar amount of food while taking a GLP-1 compared to when they weren’t, or at least an adequate amount of calories and protein for their body, some modest weight loss may occur because the underlying hormonal issues are corrected.
A few things are really important to note when we look at the “success” of patients using GLP-1s for weight loss. First of all, these drugs are meant for long-term use. Coming off of a GLP-1 will almost always result in weight regain, and previously managed blood sugar may worsen as well.
This is an important consideration particularly for patients considering using a GLP-1 prior to pregnancy. Currently, manufacturers and providers recommend discontinuing use of GLP-1s at least 2 months prior to conceiving, as we do not have enough data to show that their use is safe in pregnancy. So, some weight re-gain prior to pregnancy should be expected.
We also have data showing that using a GLP-1 prior to pregnancy may not actually improve pregnancy outcomes.
One study showed that even compared to women with similar BMIs, those taking GLP-1s preconception had higher pregnancy weight gain, and increased risk of preterm delivery, hypertensive disorders, and gestational diabetes. More research is needed on this topic, but I do have a theory that this might occur if folks are undernourished while on the GLP-1, which can cause the body to then try to protect itself and the pregnancy by compensating with overeating once the drug is stopped. My hope is that meeting 1:1 with a registered dietitian while taking the GLP-1 and when coming off, all the way through pregnancy, could help mitigate these risks.
Additionally, because appetite can be so inhibited while on a GLP-1, malnutrition can occur. We often see loss of lean muscle mass as the body starts using muscle for energy, not just fat. Muscle mass is really important for metabolic health, including in managing diabetes in and out of pregnancy. It’s also important to have adequate muscle mass before pregnancy, as pregnancy itself can be very depleting.
We can also see deficiencies in certain nutrients like B12, iron, and vitamin D - it’s unclear whether the GLP-1s cause the body not to absorb these nutrients as well, or if this is simply due to a lack of well-rounded eating. Again, this is an area where seeing a dietitian could help a lot, both through strategizing adequate calorie and protein intake to preserve muscle mass and targeted supplementation of certain micronutrients.
Finally, research shows that overall, weight loss may improve some metrics of fertility, but it may not improve actual live birth rates. Additionally, extreme weight loss can actually CAUSE infertility by triggering the hypothalamic-pituitary-ovarian access to shut down, or causing the thyroid to flare.
We also have data showing that even if weight loss doesn’t occur, nutrition and lifestyle changes can improve fertility overall pregnancy outcomes. Specifically, intuitive eating has been shown to improve weight gain in pregnancy, and blood sugar outcomes for people with gestational diabetes during pregnancy and in postpartum.
Finally, I mentioned above that metformin is another drug that can significantly improve insulin resistance, especially when paired with nutrition and lifestyle changes, and targeted supplements like inositol. Both inositol and metformin are generally considered safe in pregnancy, but it’s important to ask your doctor about all medication options available to you if you don’t feel ready to jump into using a GLP-1. If you’re interested in inositol, I’ll link a great blog post we have that talks through what it is and what brand we recommend.
I say all of this not to convince you that you shouldn’t use GLP-1s. Many people, especially those with Type 2 diabetes or PCOS, find significant symptom improvement from this class of medications. Many people can’t tolerate metformin, but are able to tolerate a GLP-1, or find that metformin simply wasn’t enough for their body’s level of insulin resistance, even if they have used inositol and made changes to their nutrition or lifestyle. That’s what medication is for!
What I do want is for you to feel informed. GLP-1s are not your only option for improving your health and fertility. They do have side effects, and they are meant for long-term use, not for the short term. On the flip side, these side effects can be mitigated by working with your doctor to find the specific drug and dose that’s best for you, and working with a registered dietitian to navigate the side effects and ensure you are adequately nourished preconception.
Ok, onto some questions I received from you all!
First, from one of our Instagram followers: “Is there legit research that taking a GLP-1 helps with endometriosis?”
I have heard more and more chatter online about GLP-1s and endometriosis, and one or two of my patients’ doctors mentioned this as a possible treatment as well. From the research I found, this is mostly theoretical at this point. One study shows that GLP-1s might improve the way that endometrial tissue responds to synthetic progestin (like what’s in birth control), and others looking at inflammatory markers in patients overall show promising results. However, these studies are still in the bench lab stage, meaning researchers aren’t necessarily testing these theories on live human subjects just yet, as they’re still looking at cells under microscopes.
Another Instagram follower asked: “Can you speak on GLP1s and pros/cons for PCOS too?”
We’ve touched on this a bit already in this episode, but I think this question is maybe getting at what the pros and cons might be for someone with PCOS even if they’re not thinking about TTC. What we know is that at least 80% of folks with PCOS have underlying insulin resistance. This is why metformin, inositol, and nutrition/lifestyle changes that improve blood sugar are first lines of treatment for PCOS. Improving blood sugar balance with a combination of medications and behaviors can help immensely with cycle regularity, acne, facial hair, intense carb cravings, and sometimes with weight concerns too. For those who cannot tolerate metformin but definitely need medication for their PCOS, GLP-1s can be a great option, and we’ve seen great success with our patients who are still able to nourish their bodies adequately while taking a GLP-1. For those who feel that the hormonal weight gain piece is something they need more support with, a GLP-1 may have a stronger impact, both because of how it targets insulin resistance and because of the appetite piece. But, also as mentioned earlier, GLP-1s are meant for the longterm, not the short term, and they do have side effects. On top of this, you don’t HAVE to lose weight in order to improve your PCOS symptoms and long term heart disease or diabetes risk, it’s likely more about health behaviors and medication than it is about the weight itself. It’s important to consider all of these factors before taking a GLP-1. Regardless of your decision to take a GLP-1, if you’ve never met with a dietitian for your PCOS, we can help out a lot in coming up with a tailored nutrition plan for you.
From a colleague who’s a gynecologist, Dr. Clara Telford, we’ve got two questions! First:
“We don’t have guidelines for additional labs in women who have undergone significant weight loss with GLP-1. Do you see any utility to obtaining iron, folate, B12, vitamin D like we do in our women who have had bariatric surgery?”
Dr. Telford is awesome - highly recommend her and her associates at Gyn OB Associates in Dallas, Texas. My answer to this question is yes! Running a complete blood count, ferritin, serum folate, and 25-hydroxy-vitamin D would be great labs to check in someone who has lost significant weight prior to pregnancy, whether it’s from dieting, bariatric surgery, or GLP-1s. Like I mentioned earlier, we don’t know if GLP-1s impact nutrient absorption like bariatric surgery does, but deficiencies in these important nutrients are common for anyone who has restricted food intake, and are also important nutrients of concern in pregnancy. Ultimately, a good prenatal vitamin should also contain all of these nutrients of concern. We help our clients choose the best prenatal for their needs, and also have a prenatal vitamin guide for sale on our website for other healthcare providers to use, or for folks who aren’t necessarily interested in 1:1 nutrition counseling with our team.
Dr Telford’s second question: “wanted to see if you had any advice for me regarding patients who have come off their GLP-1 just before becoming pregnant. I know we have limited guidelines for this specific patient populations. I notice many of them have SIGNIFICANT anxiety about weight gain in pregnancy. Would love to hear a podcast by you, read any interesting papers you’ve seen, or just hear your perspective on how we can best support these women.”
Hopefully this whole podcast episode in and of itself has been helpful, and thanks Dr. Telford for inspiring me to put it together! Ultimately, working with a dietitian to ensure you are getting enough nutrition while taking a GLP-1 could help prevent drastic rebound weight gain, and also help you strategize ways to balance your plate and add foods to your eating pattern that protect your muscle mass and help you feel more regulated around food overall. While we can’t always control what our bodies do when growing a baby, we can work on feeling more grounded that we’re doing our best to nourish our bodies appropriately, and trust that in doing so, your body will gain the amount of weight it needs to gain in pregnancy.
From my fellow prenatal dietitian and friend Katie Salmon: “Maybe a part 2 on postpartum would be interesting too! Would love to hear your thoughts and perspectives including impacts on rapid weight loss while healing.”
Katie is such a fantastic dietitian, and also has a group practice! If you live in New Jersey, I highly recommend her practice. My answer to this question could absolutely be a whole episode by itself, but I’ll try to be brief. Right now, we don’t have enough data to say whether any GLP-1 drug is safe for breastfeeding, because it’s unclear how much might get passed to an infant through breastmilk. It likely will depend on each drug, and how much you are breastfeeding. My friend and gynecologist Dr. Fran posted a video about this, which I’ll link in the show notes. If you and your doctor deem it is safe for you to take a certain GLP-1 while breastfeeding, I encourage you to meet with a dietitian to ensure that you’re able to consume enough calories and protein to support breastmilk production and continue to heal from birth. That said, even if you aren’t breastfeeding, as Katie mentioned, healing after birth is absolutely a concern here. Whether you deliver vaginally or via C-section, your body went through a major trauma, and needs a LOT of calories and protein to knit back together muscle and connective tissue, and for you to regain any muscle mass lost due to food aversions combined with high protein needs in pregnancy. So, depending on the individual, it may be best to focus on recovery for at least a month or two before you get back to taking a GLP-1, and work with both your doctor and a dietitian to figure out the best plan for your whole health, especially if you’re using the GLP-1 for diabetes management, not just for weight loss.
Thank you so much to everyone who submitted a question. I hope this podcast was helpful. As a reminder, our team of dietitians here at Feed Your Zest specializes specifically in reproductive health, and would absolutely love to help you navigate all the nuances of weight, fertility, insulin resistance, and GLP-1s. Get started with 1:1 nutrition counseling today at www.feedyourzest.com