Obesity significantly impairs female reproductive outcomes through mechanisms including anovulation, reduced implantation, and increased miscarriage risk. Glucagon-like peptide-1 receptor agonist (GLP-1 RAs), particularly semaglutide (Ozempic), demonstrate robust weight reduction efficacy and potential reproductive benefits in women with obesity and polycystic ovary syndrome (PCOS). Emerging evidence suggests improvements in menstrual cyclicity, oocyte quality, and spontaneous conception rates, mediated by both metabolic and weight loss-independent mechanisms such as reduced inflammation and androgen levels. Clinical data from randomized controlled trials and observational cohorts provide preliminary reassurance that inadvertent first-trimester exposure to semaglutide does not increase major congenital malformation risk, though concerns from animal studies necessitate cautious use. Regulatory authorities recommend discontinuation of semaglutide at least two months prior to conception, emphasizing preconception counseling and reliable contraception. Compared to other anti-obesity pharmacotherapies, GLP-1 RAs show a more favorable reproductive safety profile. However, substantial knowledge gaps remain regarding long-term reproductive outcomes, live birth rates, and offspring development, warranting further prospective studies and pregnancy registry data. This review synthesizes current medical evidence on the “Ozempic pregnancy phenomenon,” offering clinical guidance for reproductive-aged women prescribed semaglutide and highlighting priorities for future research in reproductive endocrinology.
Heimann et al. (Tue,) studied this question.