February 10, 2023
Ozempic, and it’s “little sister” medication Saxenda, have been making waves in the world of fertility medicine as they are used with increasing frequency in people who are looking to plan pregnancy. These medications, which belong to a drug class called GLP-1 agonists, have been used to increase insulin secretion in people with Type-2 diabetes. Interestingly, these medications have also been shown to help with weight-loss in people who have struggled to lose weight with lifestyle modification or other weight loss medications. Over the last 6 months, I have been seeing more people in my fertility practice who are either using this medication and want to know if it is safe for them to take while trying to conceive, or they ask if they can start using this medication to lose weight as part of their infertility management.
In the fall, I attended a talk given by Dr. Sandra Cortina of Cortina Weight Medicine (https://cortinaweightmedicine.ca/) based in New Westminster. She explained how these medications work to improve weight loss success in people who have struggled to lose weight with other methods. She also outlined how a physician not specializing in weight loss medicine can begin to use these medications in their own practices. Since attending this talk, I have started to prescribe these medications to select patients whom I see for fertility treatments. Although not suitable for everyone seeking fertility care, there are two main groups of people for whom these medications are appropriate: Patients who need to lose weight to undergo an IVF procedure, and people with a type of polycystic ovary syndrome (PCOS) characterized by irregular periods, high male hormone levels, and obesity.
Unfortunately for patients seeking pregnancy, Ozempic and Saxenda are not medications that can be used in pregnancy. There are no studies on the use of these medications in pregnancy so how they affect a developing fetus is unknown. Therefore, when I discuss the use of these medications with patients, I emphasise the need to pause or hold off on trying to conceive while we use them.
Ozempic is the most popular option for effective weight loss because it is a once-weekly injection and often results in more pronounced weight loss. However, given the half-life of the drug (how long the drugs lasts in the body), it is recommended to wait at least 3 months after stopping the medication before trying to conceive. Saxenda is a daily injection that does not result in the same degree of weight loss, but it has a shorter half life and can be stopped one month before trying to conceive. Saxenda has also been shown in a recent study (https://www.fertstert.org/article/S0015-0282(22)00271-0/fulltext) to reduce elevated male hormone levels in people with PCOS, which can have overall benefits on their health and fertility potential beyond weight loss alone.
Taking all of this into consideration, I have been using Saxenda in my practice more often. Before starting it, however, it is important to have an informed discussion about the potential benefits of the medication, the need to hold off on trying to conceive in the short term while it is being used, and any potential downsides that may be specific for the patient.
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