Ozempic, Wegovy, Mounjaro and Zepbound: fertility, birth control and pregnancy

“Additionally, some studies indicate improved spontaneous and assisted fertility, which also increases exposure risk”

“GLP1RAs usage was associated with an improvement in natural pregnancy rate (RR: 1.72, 95% CI 1.22 to 2.43, P = 0.002, I2 = 0%) and menstrual regularity (SMD: 1.72, 95% CI 0.60 to 2.85, P < 0.001, I2 = 95.6%).”

“There were no statistically significant differences in total pregnancy rate, IVF pregnancy rate between two groups”

“semaglutide pretreatment before fertility-related care was associated with reduced and delayed pregnancy and live birth outcomes in women with overweight and obesity with infertility”

“Use of ZEPBOUND may reduce the efficacy of oral hormonal contraceptives due to delayed gastric emptying. This delay is largest after the first dose and diminishes over time.”

“Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method or add a barrier method of contraception for 4 weeks after initiation and for 4 weeks after each dose escalation with MOUNJARO”

“Following administration of a combined oral contraceptive (0.035 mg ethinyl estradiol and 0.25 mg norgestimate) in the presence of a single dose of tirzepatide 5 mg, mean Cmax of ethinyl estradiol, norgestimate, and norelgestromin was reduced by 59%, 66%, and 55%, while mean AUC was reduced by 20%, 21%, and 23%, respectively.”

“No clinically relevant drug-drug interaction with semaglutide (Figure 4) was observed based on the evaluated medications; therefore, no dose adjustment is required when co-administered with semaglutide.”

“Because of the potential for fetal harm, discontinue WEGOVY in patients at least 2 months before they plan to become pregnant to account for the long half-life of semaglutide”

“Discontinue OZEMPIC in women at least 2 months before a planned pregnancy due to the long washout period for semaglutide”

“Obstetrician–gynecologists and other health care professionals should advise their patients about the current lack of sufficient safety data regarding GLP-1RA use in pregnancy and to consider discontinuation 1–2 months before conception.”

“Available data with MOUNJARO use in pregnant women are insufficient to evaluate for a drug-related risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes.”

“suggest discontinuation of glucagon-like peptide-1 receptor agonist (GLP-1RA) before conception rather than discontinuation between the start of pregnancy and the end of the first trimester”

“When a pregnancy is recognized, advise the pregnant patient of the risk to a fetus. Discontinue WEGOVY in pregnant patients who are using it for weight reduction”

“Advise pregnant patients that weight loss is not recommended during pregnancy and to discontinue ZEPBOUND when a pregnancy is recognized”

“Obstetrician–gynecologists and other health care professionals should advise against the use of GLP-1RAs during pregnancy.”

“Although some estimates were imprecise, results did not indicate a large increased risk of MCMs above the risk conferred by maternal T2D requiring second-line treatment.”

“Pregnant women exposed to WEGOVY and healthcare providers are encouraged to contact Novo Nordisk at 1-877-390-2760 or www.wegovypregnancyregistry.com.”

“Pregnant patients exposed to ZEPBOUND and healthcare providers are encouraged to contact Eli Lilly and Company at 1-800-LillyRx (1-800-545-5979).”

“There are no data on the presence of semaglutide in human milk, the effects on the breastfed infant, or the effects on milk production.”

“advise patients that breastfeeding is not recommended during treatment with WEGOVY tablets.”

“In a single-dose clinical lactation study, the concentration of tirzepatide in breast milk was found to be either undetectable or low compared to the maternal administered dose”

“If GLP-1RAs are used while breastfeeding or chestfeeding, close surveillance of neonatal weight gain, in concert with the infant’s health care professional, is recommended.”

“The quality of baseline sperm parameters of our study cohort was poor, below the 5th percentile of reference values. In the SEMA group, there was a significant increase in morphologically normal sperm from baseline to the end of the study”

“No effects of tirzepatide were observed on sperm morphology, mating, fertility, and conception. In female rats, an increase in the number of females with prolonged diestrus and a decrease in the mean number of corpora lutea resulting in a decrease in the mean number of implantation sites and viable embryos was observed at all dose levels.”