GLP-1 Agonists: Understanding Their Impact on Fertility, Contraception, and Pregnancy

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes and obesity, conditions often affecting reproductive-aged individuals. While their metabolic benefits are well-established, the specific effects of these medications on human fertility, contraceptive efficacy, and pregnancy outcomes remain less comprehensively understood. This clinical perspective review synthesizes current evidence to provide guidance on GLP-1 RA use in reproductive health contexts.

The review highlighted that GLP-1 RAs can influence ovarian function and menstrual regularity, with some studies reporting improved ovulation rates in women with polycystic ovary syndrome (PCOS) by up to 30%. Preclinical data raised concerns regarding potential teratogenic effects in early animal studies, showing a 2.5-fold increase in fetal abnormalities at high doses (e.g., 1 mg/kg daily). Furthermore, the review indicated that GLP-1 RAs might affect the pharmacokinetics of oral contraceptives, potentially reducing their efficacy by 15-20% in some individuals. The most significant finding was the strong recommendation for discontinuation of GLP-1 RAs at least 2 months prior to conception due to potential risks and the current lack of sufficient human safety data during pregnancy. This precautionary measure is advised given the limited human data and observed adverse effects in animal models.