Recent news has been filled with stories linking Ozempic use to pregnancies, highlighting two key issues. Firstly, weight loss drugs such as semaglutide and tirzepatide are associated with increased fertility and higher pregnancy rates. Secondly, there is a significant concern about the lack of information on their effects during early pregnancy.
For many women, this increased fertility is a welcome side effect. However, since these medications can also interfere with the efficacy of birth control, not all of these surprises are desired ones.
What is the correlation between Ozempic type drugs and pregnancy?
There are several factors that cause Ozempic type drugs to lead to higher rates of pregnancy.
Obesity itself is associated with hormone imbalances; fat cells can actually secrete estrogen and lead to effects on the hormone balances required to ovulate at the right time to conceive.
Obesity and PCOS are both conditions that make it hard to conceive because of irregular ovulation and insulin resistance. When you lose weight, your resistance to insulin, the hormone that helps you metabolize sugar, goes down. This makes insulin more effective and further helps to lower weight. This in turn positively affects your hormone levels and makes you more likely to be able ovulate and conceive.
These drugs also cause delayed gastric emptying-meaning food stays in the stomach for longer and makes you feel fuller longer. Having food stay in the stomach, with slower motility can also affect how medications are absorbed and in turn how effective they are. As noted in the article, only tirzepatide comes with a warning specific to birth control and this phenomenon.
What is Ozempic and how can it affect our health?
Ozempic, Wegovy, Mounjaro and Zepbound are all different medications that work to slow gastric emptying, lead to feelings of feeling fuller for longer, and in some cases, quieting the “food noise” that plague so many overweight (and non-overweight) people. These medications have been shown to, by significantly decreasing the impacts of obesity, found to lower blood sugar and overall cardiac and kidney health, especially in those patients who already have diabetes. There are many other positive impacts that reducing obesity can have on health. Lifestyle and self esteem, as well as overall heart health.
All of these medications can have subjective side effects such as nausea, vomiting, constipation, diarrhea among others. Because of the effects on the GI system, issues related to gut motility, including serious adverse events, have also been reported.
What do we know about the effects of taking these drugs on birth control?
These medications all slow gastric emptying, which can lead to changes in absorption of a medication. This can either lead to ineffectiveness because the medicine doesn’t maintain levels in the bloodstream or build up and cause toxicity. In this case, the concern is that it may delay the absorption of the birth control pill, leading to more incidences of breakthrough ovulation and thus a chance to become pregnant.
What about PCOS?
Losing even 5% of body weight can significantly improve chances of fertility. With PCOS, many women struggle with increased insulin resistance, leading to more weight gain and a vicious cycle that can lead to hormone imbalance and lower rates of ovulation. For these reasons, women with both obesity and PCOS may be affected by these medications with an increase in fertility.
Do we know about any effects and fetus?
Two animal studies have shown Ozempic to be unsafe in pregnancy, though there is no data yet in humans, as it is recommended to stop Ozempic two months prior to conception. So far, anecdotal evidence seems to support that exposure early in the first trimester of pregnancy has not been shown to be clearly linked to any specific adverse pregnancy or birth outcomes. However, it will be impossible to study properly, as women are told to stop the medications when pregnant. Retrospective data collection will be helpful over time to better address this question.
The Bottom Line
In conclusion, it is clear that this trend is real–but it is based on the secondary effects of the medications, such as weight loss, increased insulin sensitivity and better chances of ovulation and not direct fertility effects of the medications on the ovary. It is very important to note that if you are on these medications and you’ve lost weight, you should stop them two months before trying to conceive. In addition, as many women who have PCOS and are on Ozempic, Wegovy, Mounjaro or Zepbound already have irregular periods, it may take awhile to realize that a missed period means a pregnancy. Therefore, if you’re on the pill, and any of these too, and really don’t want to get pregnant, other methods of birth control may be a better idea!
