Semaglutide is a medication classified as a Glucagon-like Peptide-1 (GLP-1) receptor agonist, primarily recognized for its use in managing Type 2 diabetes and chronic weight management. It works by mimicking the naturally occurring GLP-1 hormone, which helps regulate blood sugar, slow gastric emptying, and increase the feeling of fullness. The drug’s success in promoting significant weight loss has led to questions about its role in reproductive health. Understanding how the medication balances metabolic benefits with potential effects on fertility and fetal development is important. The evidence requires a distinction between the indirect effects of weight loss and the direct pharmacological effects of the drug itself.
How Weight Loss Affects Reproductive Health
Semaglutide’s impact on fertility is currently understood to be an indirect benefit mediated by metabolic improvement. Weight loss can fundamentally alter the hormonal environment in the body, which often leads to a restoration of normal ovulatory function. For women with conditions such as Polycystic Ovary Syndrome (PCOS) or obesity-related anovulation, excess weight contributes to insulin resistance and hormonal imbalance, making conception challenging.
The reduction in body weight and improved insulin sensitivity resulting from Semaglutide use can help rebalance reproductive hormones. This change can regulate menstrual cycles, increase the frequency of ovulation, and consequently heighten the likelihood of spontaneous conception. This mechanism explains the anecdotal reports of unexpected pregnancies, sometimes referred to as “Ozempic babies,” among individuals who had previously struggled to conceive. While the drug itself is not a fertility treatment, its metabolic consequences create a more favorable biological state for reproductive function.
For male partners, the relationship between Semaglutide and fertility is linked to weight loss and improved metabolic health. Obesity is associated with impaired sperm quality and lower testosterone levels. Weight loss facilitated by GLP-1 agonists can lead to improvements in semen parameters, such as sperm count, motility, and morphology, in men with obesity. Semaglutide does not directly cause male infertility, and its indirect effects may even be beneficial for certain men.
Risks During Pregnancy and Fetal Development
The primary medical concern regarding Semaglutide use is its potential effect on the developing fetus. Due to ethical considerations, comprehensive human trials of the drug during pregnancy have not been conducted. Consequently, the available data are insufficient to determine the drug-associated risks for major birth defects or miscarriage in humans. Based on findings from animal studies, Semaglutide is generally contraindicated during pregnancy.
Studies conducted on pregnant rats, rabbits, and monkeys have shown troubling results, including an increased incidence of embryofetal mortality and structural abnormalities. Specifically, animal offspring exposed to the drug demonstrated reduced fetal growth, visceral abnormalities affecting the heart and blood vessels, and skeletal anomalies. The pharmacological reason for this risk stems from the fact that GLP-1 receptors, the drug’s target, are expressed in the placenta and in the tissues of the developing fetus.
Intentional weight loss during pregnancy is generally not recommended, as it can be associated with the risk of the baby being born smaller than average. When a pregnancy is recognized, Semaglutide should be discontinued immediately, and the patient should be advised of the potential risks based on the animal data.
Medical Recommendations for Planning Conception
Individuals planning a pregnancy while taking Semaglutide must consult with their healthcare provider to develop a safe and effective plan. A crucial step involves ensuring the drug is completely cleared from the body before attempting conception. This necessary period of discontinuation is known as a washout period.
The manufacturer and regulatory bodies generally recommend that Semaglutide be stopped at least two months before a planned pregnancy. This recommendation is based on the drug’s long half-life, which means it takes several weeks for the medication to be fully eliminated from the system. Discontinuing the medication two months prior allows adequate time for clearance, minimizing the potential for fetal exposure during the earliest and most sensitive stages of development.
During this washout period, the healthcare team will transition the patient to alternative, pregnancy-safe treatments for managing their underlying condition, such as Type 2 diabetes or obesity. Maintaining good control of blood sugar is important for maternal and fetal health throughout the pregnancy. Patients of reproductive potential are strongly advised to use effective contraception while taking Semaglutide to prevent an unplanned pregnancy. If a patient discovers they are pregnant while still taking the medication, they should contact their doctor immediately to stop the drug and enroll in a pregnancy registry for monitoring.
Regarding lactation, there is limited data on Semaglutide excretion into breast milk. While small amounts are expected to pass into the milk, it is generally advised to discontinue use while breastfeeding until more safety information becomes available.