GLP-1s and Fertility
GLP-1 medications are having a moment - and not a quiet one.
From celebrity interviews to TikTok videos to whispered - or not so whispered - conversations in the break room, medications like Ozempic, Wegovy, and Mounjaro are everywhere. They’ve quickly become some of the most talked-about prescriptions in modern medicine.
Most of the buzz is about weight loss. And yes, they can be very effective for that, but they also boast the benefit of improving insulin resistance.
What is Insulin Resistance?
Insulin is your body’s blood sugar manager. Its job is to move glucose out of your bloodstream and into your cells, where it can be used for energy. When everything is working properly, it’s a pretty seamless system. But, when the body becomes resistant to insulin, things can get a bit messier. The cells stop responding to insulin efficiently, meaning that sugar lingers in the blood stream longer than it should. In response, your body pumps out even more insulin to compensate. Now there’s high blood sugar and high insulin levels - a metabolic traffic jam that keeps building on itself.
Insulin Resistance and Fertility
Insulin has a very similar structure to luteinizing hormone (LH) - a key hormone in egg maturation and ovulation. When insulin levels are chronically elevated, the body can get its signals crossed which can negatively affect sex hormones as well as egg and sperm quality, which makes conception much more difficult. In other words, high insulin doesn’t just affect your metabolism. It can quietly disrupt your reproductive system too.
By lowering insulin resistance and reducing chronically elevated insulin levels, GLP-1 medications may help restore hormonal balance - not just metabolic health. For many folks that are trying to conceive, this can mean more predictable ovulation, improved egg maturation, better sperm production and quality, and a more supportive hormonal environment for conception.
While it seems like GLP-1s may be a no-brainer to take for fertility, there is actually a lot more nuance on this topic needed. GLP-1s are not recommended during pregnancy, and navigating the transition on and off them requires strategy - not guesswork.
GLP-1s and Pregnancy
GLP-1 medications are contraindicated in pregnancy. That means they shouldn’t be used while pregnant. However, stopping them right before or in early pregnancy can cause some ripple effects.
Some individuals who discontinue GLP-1s preconception or in early pregnancy have reported increased gestational weight gain, higher risks of gestational diabetes, greater likelihood of hypertensive disorders of pregnancy, and increased risk of preterm deliveries.(Maya, Et al.) GLP-1s improve insulin resistance and help regulate appetite, blood sugar, and weight. Removing that metabolic support - especially abruptly - can cause the body to rebound.
In addition, a suppressed appetite and GI side effects from taking a GLP-1 can lead to nutrient deficiencies and muscle loss, both of which are not ideal to start off with in pregnancy, and may in their own right cause issues with fertility.
This is why preconception planning when on GLP-1s is so important.
Transitioning Off of GLP-1s
GLP-1s are helpful but in no way magical. Coming off of GLP-1s before or during early pregnancy takes some specific planning.
While still taking a GLP-1, it’s important to build healthy, sustainable habits. This can be the key to preventing symptom rebound after stopping, navigating side effects like nausea and constipation, and avoiding nutrient deficiencies or loss of muscle mass.
Building healthy habits could look like nutrition counseling, adequate calorie and protein intake, regular movement, targeted micronutrient supplementation, behavioral strategies for stress, and more. The important thing is to rely on your resources to gain tools and knowledge that will help you to maintain the progress towards your health goals you've made on the medication, even after you come off of it.
The Bottom Line
GLP-1 medications can be extremely powerful tools. But like all tools, they require thoughtful use - especially around fertility and pregnancy.
Our team of Registered Dietitians are eager to work with you and support whatever goals you may have. Whether you feel GLP-1s are right for you or not, we’re here to support you and act like another person on your team to support your long term health. Get started today!