GLP-1 Medications and Fertility – What Women Need to Know

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

GLP-1 receptor agonist medications, including semaglutide (Ozempic), tirzepatide (Monjaro), and liraglutide (Victoza), are FDA-approved for weight loss and diabetes. And the research reveals even more potential benefits for reducing inflammation, supporting the immune system, and improving women’s health.

We’ve already discussed the use of GLP-1s combined with hormone replacement therapy in midlife women. Today’s article is for women in their reproductive years, facing PCOS and other fertility challenges.

We know that obesity and diabetes impact reproduction for both women and men, and that improving body composition and insulin sensitivity positively impact fertility. Could GLP-1s help as part of an integrative strategy?

Keep reading to discover:

• A review of GLP-1 receptor agonists and the reproduction connection
• GLP-1s and birth control interactions – important to know!
• The connection between obesity and fertility
• PCOS – do GLP-1s help?
• GLP-1s and pregnancy
• Notes from an integrative doctor

GLP-1 Receptor Agonists – A Review

Glucagon-like peptide-1 (GLP-1) is a hormone that your body naturally makes. It helps regulate insulin and glucagon for blood sugar control, the rate at which food moves through the digestive tract, and your fullness after a meal or snack.

GLP-1 medications aren’t the same as your natural GLP-1; they are receptor agonists, meaning that they work by binding to the GLP-1 receptors in the brain and body. They aren’t the hormone itself, but they cause similar actions. The medications tend to have a stronger and longer effect compared to your own GLP-1.

GLP-1 and Reproduction

You have GLP-1 receptors throughout the body, including the reproductive system, in the ovaries and uterus. Binding to the receptors supports granulosa cell proliferation, part of ovarian follicle development, ovulation, and ovarian hormone production.

GLP-1 medications have effects in the body beyond weight reduction and may support reproduction by improving metabolic function, reducing inflammation, and exerting anti-fibrotic effects.

GLP-1 medications aren’t FDA-approved for fertility, but women of reproductive age are already taking these medications, so it’s important to consider the connections.

GLP-1s and Birth Control

A GLP-1 receptor agonist may reduce the effectiveness of oral contraceptives. Tirzepatide seems to have a greater impact on the absorption of oral birth control than other GLP-1 medications.

If you are taking birth control pills intending to prevent pregnancy, please discuss contraception with your healthcare provider before beginning GLP-1 medications.

Obesity and Fertility – Possible GLP-1 Benefits

Women with higher body mass index (BMI) tend to have poorer reproductive outcomes. Along with obesity come comorbidities, such as diabetes and high blood pressure, which also affect fertility. Reducing weight and improving these comorbidities may improve the entire metabolic profile and fertility. GLP-1s may be a tool to do so.

Most of the research on the topic of obesity and fertility is in women with polycystic ovary syndrome (PCOS).

GLP-1s and PCOS

PCOS is one of the most common endocrine disorders in women and commonly affects fertility. GLP-1 use is increasing in women with a PCOS diagnosis. In 2021, 4.6% of GLP-1 users had PCOS, and in 2025, that number increased to 5.7%.

The benefits of GLP-1 medications in (overweight or obese) women with PCOS may include:

• Weight loss and reduced BMI
• Reduced waist circumference
• Lower triglycerides
• Lower androgen levels and increased sex hormone binding globulin
• Improved menstrual cycle regularity
• Increased fertility rates
• Increased pregnancy rates in natural and IVF cycles

While we need more research on GLP-1s and fertility in non-PCOS populations and women seeking fertility treatments, there is ample evidence for women with PCOS using GLP-1 medications for weight loss that the benefits extend to fertility as well.

GLP-1s and Pregnancy

It’s possible to use GLP-1 medications before pregnancy, between pregnancies, and postpartum, but GLP-1s are contraindicated in pregnancy and during breastfeeding. There is limited evidence of GLP-1 medication effects on the fetus and infant.

It’s recommended that women using GLP-1 medications discontinue the medication at least two months before trying to conceive.

An Integrative Perspective

From an integrative perspective, let’s remember that GLP-1 medications are just one tool, and they do come with side effects and important considerations.

The preconception period is incredibly important for fertility and a healthy pregnancy. It’s a time when we councel patients to build up nutrition by focusing on nutrient-dense foods. It’s often not the best time for food restriction or unnecessary weight loss in healthy-weight women. In women with PCOS, addressing metabolic health before trying to conceive is nuanced and very beneficial when you take the time to do so.

GLP-1 medication use can lead to undereating, nutrient deficiencies, and associated microbiome changes, which can affect hormone levels, ovulation, and deplete nutrient stores that are important during pregnancy.

If you’re struggling with fertility or want to optimize your chances for a healthy pregnancy, it’s important not to just jump to GLP-1s as a fertility fix. With integrative care at TārāMD, we’ll look at the full picture of your health, optimize nutrition and lifestyle, use targeted interventions, and monitor to avoid unwanted side effects.

In some cases, GLP-1s will make sense for weight loss and fertility support before conception. Still, they will work best as one part of a whole-person, whole-picture approach alongside lifestyle change and other integrative support.

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