In the USA, there is currently intense discussion regarding pregnancies occurring during the use of GLP-1 medications containing the active ingredient semaglutide—also known in the media as weight-loss injections—despite the simultaneous use of oral contraceptives (the birth control pill). Although the manufacturer states that the active ingredient semaglutide contained in the weight-loss injections does not alter the bioavailability of the hormones in the pill, reports of unexpected pregnancies during this therapy are nevertheless increasing. This controversy has also sparked a debate in Germany regarding the effectiveness of contraceptives in combination with weight-loss injections. Furthermore, the potential improvement in fertility during semaglutide therapy is being discussed, raising questions about possible effects on the desire for children among obese women.
In this article, we will delve into this current topic of discussion, "Ozempic babies," and explain the scientific data available.
What is semaglutide and how does it work?
Semaglutide is the active ingredient in so-called weight-loss injections, prescription medications used to treat type 2 diabetes and obesity. It belongs to the group of GLP-1 receptor agonists, which bind specifically to a receptor of the same name in the pancreas and act there. This stimulates the release of insulin from specific cells in the pancreas, but only when blood sugar levels are high. At the same time, the release of another hormone, glucagon, is inhibited, which reduces the production of new sugar in the liver. Furthermore, a neuronal component leads to slowed gastric emptying and an increased feeling of satiety. Due to this positive side effect, semaglutide contributes to weight loss, making it an attractive option for people with diabetes and obesity.
Contraception and possible pregnancies. What is the truth about the “Ozempic baby”?
In the USA, there are increasing reports of women who have become pregnant despite using contraceptives while taking Ozempic, one of the medications containing semaglutide. Terms like “Ozempic baby” are already circulating. Similar reports also exist for other weight-loss injections containing GLP-1 receptor agonists. Is this actually true, and why is it happening?
First of all, it is important to know that the available data on this is limited. There are no sufficient long-term data or large clinical studies that have comprehensively examined the effects of semaglutide on oral contraceptives (the birth control pill).
A small study published in the Journal of Clinical Pharmacology in 2015 examined the effects of semaglutide on the effectiveness of combined oral contraceptives. It was conducted on postmenopausal women to minimize fluctuations in hormone levels. Semaglutide was administered in weekly increasing doses while the subjects took the contraceptive for 10 days. Of the 43 participants originally included, four discontinued semaglutide treatment, and for three women, the measured levels of ethinylestradiol—the synthetic estrogen contained in most oral contraceptives—did not meet the requirements for accurate analysis. Thus, the number of women included in the results decreased further. In the evaluation, a slight delay was observed in the time at which the maximum concentration of the drug is measured in the blood when semaglutide was taken simultaneously. This does not appear to lead to a change in bioavailability in general, and the pharmacokinetic properties of semaglutide and the contraceptives remained similar both before and during semaglutide treatment. Overall, the authors conclude that semaglutide does not impair the effectiveness of the contraceptive pill.
Criticism of the study on the interaction between the birth control pill and semaglutide
However, the results of the study are only conditionally usable for various reasons. Given the very small number of 43 participants (or 39) included in the study, the validity of the results is limited. Furthermore, the study was conducted on postmenopausal women. Presumably, the results cannot be transferred 100% to women of childbearing age. It is also worth noting that the study was funded by the manufacturer itself.
Even if no conclusive studies exist to date, a reduced contraceptive efficacy while using weight-loss injections is not implausible. For instance, the manufacturer of another GLP-1 receptor agonist recommends in the patient information leaflet that women taking oral contraceptives should consider switching to non-oral contraceptive methods or using a barrier method for 4 weeks after starting and after each dose increase.
How can semaglutide impair the effect of the pill?
Taking semaglutide and other GLP-1 receptor agonists can slow down gastric emptying and be associated with side effects such as diarrhea and vomiting. This could potentially impair the effectiveness of the oral contraceptive pill.
Since the pill normally passes through the gastrointestinal tract quickly, delayed gastric emptying can mean that the pill is not fully or evenly absorbed, thereby impairing its effect.
In the event of vomiting and diarrhea within 3 hours of taking the pill, there is insufficient time for the hormones to be absorbed.
Whether there is a potential direct influence on the hormonal balance or the female cycle can currently only be speculated. Explicit studies on this are lacking. GLP-1 receptor agonists do not directly interfere with the regulation or production of estrogen and progesterone, but these are linked to many other regulatory processes in the body. For example, a known rare side effect of semaglutide is thyroid dysfunction. Thyroid hormones and sex hormones are closely linked and influence each other, and thus an effect on the menstrual cycle could potentially occur.
Conclusion on the "Ozempic babies" phenomenon
In conclusion, further long-term observational studies with a large number of participants who use both hormonal oral contraceptives and GLP-1 receptor agonists are required to make a more precise assessment of the probability of pregnancy. Conducting laboratory chemical measurements to determine hormone concentrations is difficult because women of childbearing age have natural cyclical fluctuations in hormone levels.
Safe contraception while using weight-loss injections
Option 1: Additional security
It is advisable to use additional contraception via barrier methods (e.g., condoms) at least during the fertile phase of the cycle. (According to the recommendation of a manufacturer of comparable medications, even continuously for four weeks after each dose increase).
Particular caution is, of course, required if side effects such as diarrhea and vomiting occur.
Option 2: Switch to another contraceptive
Severe overweight and obesity increase the risk of thrombosis or embolism, which can be further exacerbated by combined oral contraceptives. Considering the supposed risk of reduced contraceptive efficacy while taking semaglutide, it is recommended to speak with a doctor about alternative options if one is taking semaglutide and using the pill at the same time.
Improved fertility through semaglutide?
An interesting component in the discussion about pregnancies despite contraception and the use of the “weight-loss injection” is the potential effect of semaglutide on fertility. The body of research on the effect of semaglutide on reproductive health is limited. Some data show that semaglutide can influence the hormonal profile by lowering the concentration of free testosterone and improving menstrual regularity and ovarian function, which in turn could lead to improved fertility.
An animal model showed an extension of the estrous cycle and a slight reduction in the number of corpora lutea (which produce progesterone), particularly at higher semaglutide doses, which may be attributable to indirect effects from changes in body weight. Simply put: Weight loss can have a positive effect on fertility.
Overweight and the desire for children
In general, it can be said that overweight and obesity can lead to various problems in the female body, especially regarding the menstrual cycle and fertility. For example, it can lead to hormonal disorders, irregular periods, and infertility in younger women. A common cause for such disorders is polycystic ovary syndrome (PCOS), which often occurs in women with obesity. PCOS affects the hormonal balance and ovarian function, which can impair fertility. Even if there is no direct link between BMI and fertility, studies show that overweight and obesity increase the risk of cycle disorders and PCOS, which can decrease the chance of pregnancy. Research on PCOS patients shows that semaglutide can improve metabolic parameters, reduce their weight, and increase their insulin sensitivity (70% of PCOS patients exhibit insulin resistance).
According to a study by the American Society for Reproductive Medicine, even a moderate weight loss of 5–10% in overweight women can significantly improve the probability of pregnancy. This is partly because a healthier weight improves the regularity of the menstrual cycle and can promote the frequency of ovulation or the chance of ovulation occurring.
The role of overweight in men regarding the desire for children
It is not only the woman's fertility that is crucial for pregnancy: in couples wishing to conceive, male infertility contributes to about 40 to 50% of fertility problems. Overweight men have more frequent problems with sperm production. One study found that couples with overweight male partners had a lower chance of a live birth when they underwent fertility treatments. Other data show that after medically supervised weight loss in men, significant improvements occur in various areas, such as male hormone levels, sperm motility and shape, the weight of reproductive organs, and sexual function. Weight loss in men could therefore be beneficial for couples with fertility problems to improve their chances of a successful pregnancy.
According to the current state of knowledge, the effect of supposedly improved fertility through the use of weight-loss injections is most likely due to the weight loss itself.
Semaglutide during pregnancy & breastfeeding
There is currently little data available on pregnancy and breastfeeding, and the available information is largely based on animal studies. These studies showed a low birth weight of the fetus or fetuses, as well as an increased miscarriage rate, when animals were treated with semaglutide. Women wishing to conceive should therefore stop taking medications with semaglutide at least 2–3 months before planning a pregnancy.
Furthermore, it is important to take a test promptly or consult a doctor if pregnancy is suspected, in order to have the option of stopping the medication quickly.
Additionally, it is important to maintain open communication with the treating physician and to address all questions or concerns regarding contraception and potential pregnancies. The doctor can provide individual advice and recommendations based on the specific circumstances and needs of each patient.
Conclusion on the topic "Unplanned pregnancy due to semaglutide and other GLP-1 medications"
Pregnant "due to" the weight-loss injection? An unplanned pregnancy is theoretically possible while using weight-loss injections despite using the pill, but there is currently no scientific evidence that a concrete interaction between the two medications is behind it. It is important to understand the potential risks and take precautions to avoid unwanted pregnancies. Open communication with the doctor can help ensure one's own safety and health while using these medications.
The increased fertility in women and men after medical weight loss appears to be due to the indirect effects resulting from the change in body weight on the reproductive organs.
Whether medical weight-loss therapies can improve fertility through weight loss itself or through a potential direct effect on the reproductive and hormonal system remains to be investigated in explicit studies.
Sources
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Pavli P, Triantafyllidou O, Kapantais E, Vlahos NF, Valsamakis G. Infertility Improvement after Medical Weight Loss in Women and Men: A Review of the Literature. Int J Mol Sci. 2024 Feb 5;25(3):1909. doi: 10.3390/ijms25031909. PMID: 38339186; PMCID: PMC10856238.
Nuako A, Tu L, Reyes KJC, Chhabria SM, Stanford FC. Pharmacologic Treatment of Obesity in Reproductive Aged Women. Curr Obstet Gynecol Rep. 2023 Jun;12(2):138-146. doi: 10.1007/s13669-023-00350-1. Epub 2023 Feb 27. PMID: 37427372; PMCID: PMC10328448.
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