GLP‑1 medications and fertility: pregnancy and contraception

Introduction

GLP‑1 medicines are not established fertility treatments, but pregnancy can occur while you take them. If you use semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound), discuss contraception and pregnancy plans with your prescriber before treatment. Reports of “Ozempic babies” do not prove that these medicines restore fertility. 1

Fertility research focuses on specific groups

A 2023 systematic review included 11 randomized trials with 840 women who had polycystic ovary syndrome (PCOS). Researchers found improvements in natural pregnancy rates and menstrual regularity across the included studies. The trials studied exenatide or liraglutide, sometimes with metformin, for different lengths of time and against different comparison treatments. 1

Those findings do not establish an expected pregnancy rate for semaglutide or tirzepatide. Weight and metabolic changes may help some women with PCOS, but fertility depends on several factors. Discuss changes in your menstrual cycle with your clinician; a more regular cycle does not confirm ovulation or guarantee conception.

Tirzepatide requires a specific birth-control precaution

Tirzepatide delays stomach emptying and can reduce the effectiveness of oral hormonal contraceptives. The U.S. Mounjaro and Zepbound labels advise switching to a non-oral contraceptive method or adding a barrier method for four weeks after starting treatment and four weeks after each dose increase. This includes the initial dose, not just later increases. 2 3

Non-oral hormonal contraceptives should not be affected by that interaction. Ask your clinician or pharmacist which option suits you rather than assuming you need a particular device or method. Semaglutide does not carry the same label instruction for contraceptive backup; vomiting or severe diarrhea can still affect contraceptive-pill use, so follow the pill’s instructions and seek pharmacy advice. 2 4 5 6

Plan the stopping date before trying to conceive

For semaglutide, the Ozempic and Wegovy prescribing information advises stopping at least two months before a planned pregnancy. 4 5

For tirzepatide, UK MHRA guidance specifies at least one month before trying to conceive. The U.S. Zepbound instructions say to stop when you learn you are pregnant. They do not specify how long to wait between stopping and trying to conceive. Confirm the plan with your prescriber using the guidance for your medicine and country. 2 6

Before trying to conceive, arrange an appointment to plan your last dose, how long to keep using contraception, and any diabetes treatment you may need. Our guide to how long these medicines stay in your body explains why these medicines remain in the body after the last dose.

Studies of use during pregnancy do not prove safety

A 2026 U.S. insurance-claims study examined 3,572 pregnancies among women with a GLP‑1 prescription before pregnancy. Researchers compared women who continued filling prescriptions in the first trimester with those who stopped filling them. Both groups had prescriptions before pregnancy, so this was not a comparison with women who had never used a GLP‑1. Researchers found no clear increase in the problems they studied. However, the results were too uncertain to rule out an increased risk of major birth defects or babies being smaller than expected for their stage of pregnancy. 7

A prescription record also cannot tell researchers what doses someone took. This study does not show that using a GLP‑1 for weight loss during pregnancy is safe.

If you become pregnant during treatment, contact your prescriber and pregnancy-care team promptly. The instructions for Wegovy used for weight loss and for Zepbound say to stop when you learn you are pregnant. If you take medication for diabetes, your team should arrange appropriate blood-glucose management. Share your dose dates with your care team. Taking a dose before learning you are pregnant does not mean harm has occurred. 2 3 4 5

Keep a treatment record with Shotsy

Shotsy keeps dose dates and notes together for appointments. It does not predict ovulation or determine whether a medication exposure is safe in pregnancy.

Conclusion

Discuss pregnancy plans before starting treatment, and use the contraception advice for your specific medicine. Your prescriber and pregnancy-care team can coordinate stopping dates and any replacement treatment you need.