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Could weight-loss drugs fight infertility? Users report surprise pregnancies

Could weight-loss drugs fight infertility? Users report surprise pregnancies
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Women on weight-loss drugs report surprise pregnancies, giving hope to those made infertile by hormonal disorder PCOS

A surprising thing is happening to some women on weight-loss drugs who have struggled with fertility issues: they are getting pregnant.

That is leading to questions about the safety during pregnancy of medications Ozempic from healthcare company Novo Nordisk and Mounjaro from medicine company Eli Lilly.

“I thought I couldn’t have any more kids,” said Torria Leggett, 40, who had been trying for another after her first child was born in 2018. In 2022, the social worker from the US state of North Carolina began taking Ozempic to treat obesity, then switched to Mounjaro.

As the pounds melted off, there was soon another reason to celebrate. She was expecting.

Some women who got pregnant on a weight-loss drug have questions about their baby’s health. Photo: Shutterstock

“The weight loss, that’s likely what jump-started it,” she said. “I couldn’t believe it.”

Stories like these are encouraging doctors to use these GLP-1 (glucagon-like peptide 1) drugs – mainly used to help manage blood sugar levels in people with type 2 diabetes, and more recently to treat obesity – to treat polycystic ovary syndrome (PCOS), one of the leading causes of infertility globally.

Yet they are doing so without much data on the drugs’ impact on pregnancy.

“The ‘oops’ babies on Ozempic and Wegovy are happening all over the place,” said Melanie Cree, director of the PCOS clinic at Children’s Hospital Colorado in the US.

“It’s very exciting, but it’s a bit scary because we’re moving forward without all the data.”

Melanie Cree is the director of the PCOS clinic at Children’s Hospital Colorado in the US. Photo: University of Colorado

The need for treatments is severe. Despite its prevalence, no drugs are approved for PCOS, and experts are divided on whether recommended diet programmes work. Some doctors and patients are willing to try almost anything, and the successes are tantalising.

GLP-1 drugs have been marketed for nearly 20 years to treat diabetes, and their use in obesity is fuelling a new market that is expected to hit US$100 billion in 2030.

The problem is that companies have not systematically studied GLP-1’s use in PCOS – and do not plan to any time soon.

In the absence of data, researchers are doing studies of their own to figure out if the drugs work for PCOS, and US regulators have asked the companies to collect any information they can about their use during pregnancy.

Wegovy, whose active ingredient is semaglutide, is an injectable drug developed to treat diabetes. Wegovy is also prescribed for weight loss. Photo: Getty Images

Long-term safety data limited

So far, the safety data looks promising. A recent study of the health records of 50,000 women with type 2 diabetes found no increase in birth defects among those who used the drugs in very early pregnancy compared with those who took insulin.

Still, the study’s authors said additional confirmation is needed, especially in women without diabetes.

Researchers from Copenhagen, Denmark, concurred last year in a review of GLP-1 drugs, saying that there is “limited information on their long-term safety, particularly concerning pregnancy outcomes”.

Reasons for concern come mostly from animal experiments. The active ingredient in Novo Nordisk’s drugs, semaglutide, has been linked to increased birth defects in animals.

Similar studies of Eli Lilly’s drugs have shown there “may be risks to the fetus” from exposure during pregnancy, the company said.

Researchers are scrambling to set up their own databases to track pregnancy outcomes in patients who are taking GLP-1 drugs. Photo: Shutterstock

No one is exactly sure how – or even whether – the drugs contribute to women becoming pregnant.

Weight loss is known to boost fertility in women with PCOS, and studies have shown that Saxenda, an older obesity drug, also raised pregnancy rates in women with the disorder who were overweight.

GLP-1s may also have hormonal effects that promote fertility and may blunt the impact of oral contraceptives. Some experts think the drugs might even have a role in male infertility.

Rekha Kumar, a reproductive endocrinologist at Weill Cornell Medicine in New York, says GLP-1 drugs “wake up the ovaries”, resetting the reproductive environment for normal function.

After treating patients with infertility and obesity for more than 15 years, one thing is clear, Kumar said: “These patients are becoming very fertile.”

Pregnant people and those planning to get pregnant were excluded from trials of GLP-1s. Trial participants have been required to use contraception, and treatment was discontinued for those who became pregnant during clinical trials of Mounjaro and Zepbound, Eli Lilly said.

Rekha Kumar is a reproductive endocrinologist at Weill Cornell Medicine in New York. Photo: Weill Cornell Medicine

Conflicting advice

Experts are split on how soon patients should stop taking the medications before a planned pregnancy. Some doctors are telling patients that up to four weeks is safe; others say it is fine to keep using them up until the time of pregnancy.

Wegovy’s label says people should stop taking the drug at least two months before trying to get pregnant, while Zepbound’s recommends that people who become pregnant stop the drug.

In Colorado, Cree is running a study to find out how Novo Nordisk’s Wegovy affects ovulation in women with PCOS, but ongoing supply problems with the popular drug present a challenge. Novo Nordisk will not provide free supplies because the patients will not be on birth control, she said, a decision she called “very disappointing”.

Meanwhile, a study found that the number of women exposed to GLP-1 drugs during early pregnancy appears to be increasing, as more turn to them for diabetes and other conditions.

The private Facebook group “I got Pregnant on Ozempic” has 630 members; on TikTok, dozens have said they have become pregnant while taking a GLP-1 drug.

Ozempic is a semaglutide injection drug used for treating type 2 diabetes. Photo: Reuters

The US Food and Drug Administration asked Novo Nordisk to set up a registry to collect data on those who got pregnant while taking Wegovy, but the company has yet to share any results.

It is also required to do an additional pregnancy study using insurance claims or electronic medical records, the FDA said.

Eli Lilly is planning to set up a similar registry but declined to say when. Meanwhile, Cree and a handful of researchers are scrambling to set up their own databases to track pregnancy outcomes in GLP-1 patients.

PCOS symptoms’ improve ‘significantly’

PCOS is a condition that typically involves irregular ovulation and high levels of male hormones called androgens. It is the most common hormonal disorder in women, putting them at increased risk of diabetes, heart disease and mental health issues.

Those with the condition frequently make too much testosterone, leading to effects like extra hair growth, acne and weight gain, and blocking ovulation. They also do not respond properly to insulin, and the weight-loss effects of GLP-1s may improve sensitivity to the hormone.

Ricardo Azziz is a PCOS expert and a professor at the University of Alabama at Birmingham and State University of New York. Photo: Georgia Regents University

The new drugs “are not going to cure you, but [they are] going to improve the symptoms significantly”, said Ricardo Azziz, a PCOS expert and professor at the University of Alabama at Birmingham and State University of New York.

Still, he also thinks more data is needed before doctors recommend the drugs for fertility.

People like Leggett, who got pregnant on a weight-loss drug, have some questions. She sometimes wonders why her daughter is smaller than other kids the same age.

“She’s teeny-tiny,” Leggett said. “I’d like to know more about that.”

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