He boom The hype unleashed by the weight-loss potential of GLP-1 analogue drugs (Ozempic being its most famous exponent) has created a stir rarely seen in the pharmaceutical industry, to the point that Novo Nordisk, the Danish company that developed it, has become the most valuable company in Europe, surpassing the French luxury giant LVMH. In fact, the prestigious magazine Science GLP-1 analogues were chosen as the scientific breakthrough of 2023 for the impact they have shown in reducing cardiovascular accidents and for the possibilities they open up in fields as diverse as addictions, Alzheimer’s and Parkinson’s. There is even debate about their effects on fertility, to the point that there is already talk of ozempic babiesBut is that so?
Through social media, several women, especially in the United States, have announced pregnancies as a result of taking Ozempic despite having been diagnosed with infertility or taking the contraceptive pill. “It is known that obesity, in itself, is associated by different mechanisms with infertility. Therefore, if you lose weight, many of the negative signals generated by obesity and that can affect reproduction, theoretically should be corrected,” Juanjo Espinós, president of the Spanish Fertility Society (SEF), explains to EL PAÍS.
“It is likely that the medication produces an improvement in fertility given the weight loss it induces,” agrees Ana de Hollanda, an endocrinologist at the Hospital Clínic in Barcelona. Women with obesity and metabolic problems can suffer alterations in their hormonal cycles, in ovulation and even in the implantation of embryos. “The improvement in menstrual cycles could be a side effect,” stresses the coordinator of the obesity area of the Spanish Society of Endocrinology and Nutrition (SEEN). To date, there are no studies in humans that evaluate the change in fertility through these medications, says the expert, although she recognizes that “independent effects mediated by the medications at a hormonal level cannot be ruled out.”
Cristóbal Morales has participated in clinical trials of these drugs in recent years, and adds that they have long considered the possibility that Ozempic could improve fertility “because the relationship between obesity, adiposity and infertility is very common. Also with polycystic ovary syndrome, one of the main causes of infertility and closely associated with overweight and obesity.” Study published in 2020in this regard, concluded that the effects of GLP1 analogue drugs on weight loss offered “a unique opportunity to expand the treatment options available to patients with polycystic ovary syndrome.” Another most recent revisionpublished a year ago in the scientific journal Obstetrics & Gynecology International Journalalso concluded that GLP1 analogues “have demonstrated potential as new fertility treatments due to their effects on weight loss, endometrial receptivity and ovarian function.”
Morales, head of the Metabolic Health Unit at Vithas Hospital in Seville and member of the Spanish Society of Obesity (SEEDO), explains: “In people who are infertile or who do not ovulate, the effect of losing fat mass improves fertility by up to 30% and the patient’s hormonal cycles are restored and she ovulates again. It has been known for many years that programs aimed at losing weight, and even treatments for type 2 diabetes such as metformin, which improve insulin resistance, had a positive effect on the rate of in vitro fertilization.” recently published document led by SEENin fact, warned about this relationship and the need to prioritize women with obesity and infertility from the age of 35 on the waiting lists for bariatric surgery. “Weight loss, whether through the help of medication or bariatric surgery, can help improve fertility or make treatments such as in vitro fertilization more successful,” says Ana de Hollanda.
“Will these drugs probably end up being used in reproduction? I have no doubt, especially in patients who are very obese and who need to lose weight very quickly,” says Juanjo Espinós, an opinion also shared by Cristóbal Morales. “Although it is not specified in the technical data sheet, it is understood that infertility associated with overweight would be among those related problems,” says the SEEDO spokesperson.
Risks with the contraceptive pill
Although, through testimonies on social networks, cases of Ozempic users who say they have become pregnant despite taking the contraceptive pill have come to light, the technical data sheet for Ozempic and Wegovy indicates that “semaglutide is not expected to reduce the effect of oral contraceptives.” The pharmaceutical company Lily, for its part, acknowledged that it has observed that its drug, Mounjaro, has shown “a reduction in the maximum concentration of the oral contraceptive in the blood of up to 66% after a single dose.” Is this enough to explain the phenomenon of Ozempic babies? “This reduction is not considered clinically relevant and the pharmaceutical company does not recommend adjustments in the dose of oral contraceptives,” argues Ana de Hollanda. Cristobal Morales is of the same opinion, but is nevertheless in favour of warning users of these drugs that this risk exists, however small, so that they can look for other contraceptive alternatives. “Whenever you take a drug that metabolizes oral contraceptives quickly in the liver, it is advisable to take other types of precautions,” adds Juanjo Espinós.
In any case, all the experts consulted agree on the importance of informing all patients that taking Wegovy or Mounjaro to lose weight can resume ovulation and increase the chances of unplanned pregnancies. “It never hurts to be extra cautious, since the consequences for babies are not predictable,” says the spokesperson for SEEN, who recommends stopping the medication two months before conception if a pregnancy is being sought, since, although both drugs have demonstrated a good safety profile, their effects on pregnancy are not known.
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