After Wynter Mitchell endured three back-to-back unsuccessful pregnancies, her doctor advised her to look into in vitro fertilization. But she noticed the IVF specialists always focused on her weight.
They considered it a “hurdle” to the procedure, says Mitchell, who had a body mass index of 40 at that point, which is sometimes categorized as severe obesity.
She’s had polycystic ovary syndrome since she was a teenager and always had issues with her weight, she explains.
Women with PCOS have a hormonal imbalance and metabolism problems, with symptoms that include weight gain or difficulty losing weight, according to the Office on Women’s Health.
When the pounds wouldn’t come off despite working out and eating well, Mitchell shared her frustrations in a Facebook group for women trying to conceive. Someone suggested Ozempic, the Type 2 diabetes treatment. One of its side effects is weight loss.
Mitchell, who has insulin resistance because of PCOS, says she had no problems getting a prescription. She started taking Ozempic in July of 2022.
“Within a month, I dropped 20 pounds and it was marvelous. I couldn’t believe it. I hadn’t lost that much weight since I was in my mid-30s. I just said, this is a way forward. This is going to get me to the finish line,” Mitchell, 43, a digital strategist who lives in Los Angeles, tells TODAY.com.
“If I got down to a weight that was reasonable for me to be seen, which seemed like it was a BMI of under 35 for all of these specialists, then there would be no question at this point. I would have a successful stimulation and a successful (egg) retrieval, which I ultimately ended up having.”
Mitchell’s BMI dropped to 33. She has lost 50 pounds so far and wants to continue taking Ozempic until she loses 30 more. She hopes that will put her in the best position when it’s time to place the embryo.
Ozempic and fertility
It’s possible that using medications like Ozempic or its sister-drug Wegovy, which is specifically approved for weight loss, may improve a woman’s chances of conceiving if she has insulin resistance or obesity, says Dr. Alex Robles, a reproductive endocrinologist at Columbia University Fertility Center in New York.
The drugs themselves don’t boost fertility, but could put a woman’s body into a more optimal state for conception before she tries to get pregnant, he adds.
There’s an association between obesity and infertility, Robles notes. Obese women can have hormonal disruptions that lead to irregular periods — a signal they’re not ovulating regularly. But even modest weight loss can restore the normal hormonal processes that allow ovulation to happen, he says.
It can help with egg retrieval during IVF as well because visualizing and accessing the ovaries in patients who have more body fat can be challenging, Robles explains.
Women with obesity also have significantly higher risk of miscarriage, fetal death and still birth, he says. When the scale doesn’t budge with diet and exercise, he’s noticed some of his patients have been turning to drugs like Ozempic ahead of getting pregnant.
“The best bet is to try to use this medication at least a few months before actually trying to conceive to see if you can achieve the benefit,” Robles says.
On the flip side, he’s seen some data that using Ozempic could potentially negatively impact levels of luteinizing hormone and follicle stimulating hormone — both important for the reproductive system — but that’s likely in the context of rapid excessive weight loss, Robles says.
In a statement to TODAY.com, Novo Nordisk, which makes both Ozempic and Wegovy, says it doesn’t have clinical data evaluating the effect of the drugs on fertility treatments.
Ozempic is not approved for weight management, the pharmaceutical company adds.
“While we recognize that some healthcare providers may be prescribing Ozempic for patients whose goal is to lose weight, we do not promote, suggest, or encourage off-label use of our medicines,” Novo Nordisk says in the statement.
“We trust that healthcare providers are evaluating a patient’s individual needs and determining which medicine is right for that particular patient.”
Can you take Ozempic while pregnant?
Women should stop taking Ozempic and Wegovy at least two months before a planned pregnancy, according to the prescribing information for both drugs.
That’s how long it could take for the drugs’ active ingredient, semaglutide, to completely clear out of a woman’s system, which is important because doctors don’t know how it affects pregnant patients, Robles says.
Wegovy may cause fetal harm and should not be taken during pregnancy, according to the drug’s prescribing information.
When it comes to Ozempic, it should be used during pregnancy only if the potential benefit justifies the potential risk, the prescribing information warns. It notes doctors should consider both the risks of poorly controlled diabetes in pregnancy and the potential risks to the fetus from exposure to semaglutide during pregnancy.
About 45% of pregnancies in the U.S. are unintended, according to the Centers for Disease Control and Prevention.
Since many women of childbearing age may be interested in taking Ozempic or Wegovy for weight loss, some doctors worry this population doesn’t know enough about the potential risks if an unplanned pregnancy were to happen while they’re on the immensely popular medications.
Dr. Manijeh Kamyar, a maternal-fetal medicine specialist and OB-GYN in Las Vegas, Nevada, says patients usually tell her no one has discussed the risks with them.
“I think that that’s a huge gap in the use of this medication, especially when something like this ramps up so quickly,” Kamyar tells TODAY.com.
“My recommendation is: While you’re on this treatment — if your doctor has decided it’s the best for you — you should definitely be on some type of birth control. Because if you accidentally get pregnant while on this, I don’t know what that’s going to mean for your pregnancy… I cannot guarantee the safety of this medication in pregnancy.”
The safety data doesn’t exist in humans right now, both Kamyar and Robles say. It may come after years of people using these medications and accidentally becoming pregnant while on them, they add.
Animal data from pregnant rodents, rabbits and monkeys exposed to semaglutide showed structural abnormalities in fetuses and early pregnancy losses, according to the prescribing information for Ozempic and Wegovy.
Besides stopping the medication at least two months before a planned pregnancy, both Kamyar and Robles advise women to avoid using Ozempic or Wegovy while they’re pregnant or breastfeeding.
“It’s very likely that these medications will be excreted in the breast milk. And again, we just don’t know what the effects of this particular drug are on the fetus or the baby,” Robles says.
There is no data on the presence of semaglutide in human milk, the effects on the breastfed infant or the effects on milk production, according to the prescribing information for Ozempic and Wegovy.
If a woman unexpectedly becomes pregnant while taking these drugs, she should tell her doctor as soon as possible, both Kamyar and Robles advise. She and her fetus will likely be monitored more closely than a typical patient, Robles adds.
Not a ‘silver bullet’ for fertility
Mitchell hopes to have the embryo from her IVF procedure placed later this year. She says she’ll stop taking Ozempic before and during the pregnancy, but thinks she’ll revisit the treatment after she stops nursing.
Medication like Ozempic likely is not the “silver bullet” to help women struggling with fertility get pregnant, but it could be a potential adjunct if a patient has obesity or insulin resistance, Robles says.
Kamyar says the medication could be helpful in those cases, but still recommends making lifestyle changes like diet and exercise first to lose weight that way.
She doesn’t think there’s enough information about how these drugs might affect women of childbearing age and pregnant women.
“Research in this area needs to be expedited and physicians really need to do their due diligence in counseling patients that we do not have this data,” Kamyar says.
