Does Wegovy Affect Male Fertility? UK Evidence and Guidance

Wegovy (semaglutide 2.4 mg) is a GLP-1 receptor agonist licensed in the UK for chronic weight management in adults with obesity or overweight with weight-related comorbidities. As more men use this once-weekly injectable medication, questions about its potential effects on male fertility have become increasingly common. Obesity itself significantly impairs male reproductive function through hormonal disruption, reduced sperm quality, and metabolic dysfunction. Understanding whether Wegovy directly affects fertility—or whether weight loss achieved through treatment may actually improve reproductive health—is crucial for men planning conception. This article examines current evidence, potential mechanisms, and practical considerations for men concerned about fertility whilst using Wegovy.

Understanding Wegovy and Male Reproductive Health

Wegovy (semaglutide 2.4 mg) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for chronic weight management in adults with obesity (BMI ≥30 kg/m²) or overweight (BMI ≥27 kg/m²) with at least one weight-related comorbidity. As an injectable medication administered once weekly, Wegovy works by mimicking the natural hormone GLP-1, which regulates appetite and food intake through actions on the brain's satiety centres.

While Wegovy has marketing authorisation for these indications, NHS access is more restricted. NICE Technology Appraisal 875 limits NHS provision to specialist weight management services with specific eligibility criteria.

For men considering or currently using Wegovy, questions about reproductive health are increasingly common, particularly regarding potential effects on fertility. Male fertility depends on multiple factors, including sperm production (spermatogenesis), sperm quality, hormonal balance, and overall metabolic health. The relationship between obesity and male fertility is well-established—excess body weight can negatively impact testosterone levels, sperm parameters, and reproductive function.

Understanding the distinction between direct drug effects and the benefits of weight loss itself is crucial. Obesity is associated with reduced sperm count, decreased sperm motility, increased DNA fragmentation, and hormonal imbalances that impair fertility. Therefore, medications that promote significant weight loss may indirectly improve reproductive health by addressing these obesity-related factors.

Currently, there is limited specific research examining Wegovy's direct effects on male fertility in humans. Most available data comes from broader studies of semaglutide in diabetes management or weight loss trials that did not specifically assess male reproductive outcomes. This article examines the current evidence, potential mechanisms, and practical considerations for men concerned about fertility whilst using Wegovy.

Does Wegovy Affect Male Fertility? Current Evidence

There is no official established link between Wegovy and impaired male fertility based on current clinical evidence. The medication's Summary of Product Characteristics (SmPC) does not list male infertility or reduced sperm quality as recognised adverse effects. According to the SmPC, animal studies have not shown direct harmful effects on male fertility, though comprehensive human fertility studies are lacking.

Importantly, there is no recommendation in the UK product information for men to discontinue semaglutide before attempting conception.

The European Medicines Agency (EMA) European Public Assessment Report (EPAR) and the Medicines and Healthcare products Regulatory Authority (MHRA) approved Wegovy without specific warnings regarding male fertility, suggesting regulatory review of available data did not identify concerning signals.

Clinical trials of Wegovy primarily focused on weight loss efficacy and cardiovascular outcomes rather than reproductive health markers. Consequently, detailed assessments of sperm count, motility, morphology, or hormonal profiles were not routine endpoints in these studies. This represents a knowledge gap rather than evidence of harm.

Importantly, the indirect effects of weight loss achieved through Wegovy may actually benefit male fertility. Research consistently shows that obesity impairs reproductive function through multiple mechanisms, including reduced testosterone, increased oestrogen conversion in adipose tissue, oxidative stress, and inflammatory processes that damage sperm. Men who achieve significant weight loss often experience improvements in testosterone levels and sperm parameters.

For men actively trying to conceive, discussing individual circumstances with a healthcare provider is essential, as the balance between potential medication effects and the proven fertility benefits of weight loss varies by person.

If you experience any suspected side effects while taking Wegovy, report them through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

How Weight Loss Medications May Impact Sperm Quality

The relationship between weight loss medications and sperm quality involves both direct pharmacological effects and indirect metabolic improvements. Understanding these mechanisms helps contextualise potential fertility implications of Wegovy and similar treatments.

Direct pharmacological considerations include the medication's mechanism of action and tissue distribution. Semaglutide acts primarily through GLP-1 receptors in the brain, pancreas, and gastrointestinal tract. Some preclinical research suggests GLP-1 receptors may exist in various tissues, potentially including reproductive organs, though the clinical significance of semaglutide binding to these receptors regarding fertility remains unclear and unestablished. The medication's effects on insulin sensitivity, glucose metabolism, and inflammation could theoretically influence the hormonal environment necessary for optimal spermatogenesis.

Indirect benefits through weight loss are potentially more significant. Obesity causes:

• Hormonal disruption: Excess adipose tissue converts testosterone to oestradiol through aromatase enzyme activity, reducing bioavailable testosterone

• Increased scrotal temperature: Abdominal fat can raise testicular temperature, impairing sperm production

• Oxidative stress: Obesity generates reactive oxygen species that damage sperm DNA

• Inflammation: Chronic low-grade inflammation affects sperm quality and function

Studies of bariatric surgery and intensive lifestyle interventions show mixed effects on male fertility. While substantial weight loss often improves hormonal profiles and may enhance sperm parameters in the longer term, some research indicates potential short-term declines in semen quality following rapid weight loss. Micronutrient deficiencies after bariatric procedures can also negatively affect fertility, highlighting the importance of nutritional monitoring.

Nutritional considerations also matter. Rapid weight loss or inadequate nutrition during treatment could theoretically affect fertility if essential nutrients (zinc, selenium, folate, antioxidants) become deficient. Maintaining a balanced diet whilst taking Wegovy supports both weight management and reproductive health. Consider dietitian input if experiencing significant weight loss or persistent gastrointestinal side effects.

What Men Should Know Before Starting Wegovy

Men considering Wegovy should discuss several important factors with their healthcare provider, particularly if planning to conceive in the near future. Informed decision-making requires understanding both the medication's profile and individual fertility considerations.

Timing and conception planning warrant careful thought. Spermatogenesis (sperm production) takes approximately 74 days, meaning changes to sperm quality from metabolic improvements or medication effects may not be apparent for 2–3 months. Men actively trying to conceive should discuss whether starting Wegovy aligns with their reproductive timeline or whether delaying treatment might be appropriate. The UK product information does not specifically advise men to stop semaglutide before conception attempts; this decision should be individualised with clinical guidance.

Pre-treatment fertility assessment may be valuable for some men, particularly those with:

• Known or suspected fertility issues

• Advanced paternal age (over 40 years)

• Significant obesity (BMI >35 kg/m²)

• Underlying conditions affecting fertility (diabetes, hypogonadism)

Baseline semen analysis and hormonal assessment (testosterone, luteinising hormone, follicle-stimulating hormone) provide reference points for monitoring during treatment.

Lifestyle optimisation enhances both weight loss success and fertility outcomes. Men should:

• Maintain adequate protein intake to preserve lean muscle mass

• Ensure sufficient micronutrient intake, particularly zinc, selenium, and vitamins C and E

• Avoid excessive alcohol consumption

• Cease smoking, which independently impairs fertility

• Engage in regular physical activity

Monitoring during treatment allows early identification of concerns. Men should report any changes in sexual function, libido, or testicular symptoms to their GP. Whilst Wegovy is not known to cause these issues, individual responses vary.

Seek urgent medical attention for acute testicular pain, new testicular lumps or swelling, or systemic symptoms that might indicate serious pathology.

The balance of benefits and theoretical risks generally favours treatment for men with obesity-related health conditions, as the proven fertility impairments of obesity likely outweigh any unconfirmed medication risks.

Discussing Fertility Concerns with Your Healthcare Provider

Open communication with healthcare professionals is essential for men navigating fertility concerns whilst considering or using Wegovy. Your GP or specialist can provide personalised guidance based on your medical history, fertility goals, and individual circumstances.

Prepare for your appointment by documenting:

• Your conception timeline and any previous fertility investigations

• Current medications and supplements

• Relevant medical history (diabetes, hormonal conditions, previous surgeries)

• Lifestyle factors (alcohol use, smoking, occupational exposures)

• Any changes in sexual function or symptoms since starting treatment

Questions to discuss with your healthcare provider include:

• Whether Wegovy is appropriate given your fertility goals and timeframe

• Whether baseline fertility testing is recommended before starting treatment

• How to optimise nutrition and lifestyle for both weight loss and fertility

• When to consider referral to a fertility specialist if conception does not occur

• Whether alternative weight management approaches might be preferable

NICE guidance on fertility assessment (CG156) recommends that couples should be offered investigation if pregnancy has not occurred after 12 months of regular unprotected intercourse. Earlier investigation (after 6 months) is appropriate if the woman is aged 36 or over, or if there are known fertility risk factors. Men using Wegovy who have not conceived within these timeframes should request fertility evaluation.

Specialist referral to a reproductive medicine consultant may be appropriate if:

• Semen analysis reveals abnormalities (typically confirmed with repeat testing)

• Hormonal imbalances are detected

• Conception has not occurred within the timeframes outlined by NICE

• There are complex medical factors affecting fertility

Your healthcare provider can coordinate care between weight management, fertility services, and any other specialists involved in your treatment. This integrated approach ensures that decisions about Wegovy use consider your complete health picture and reproductive goals.

Remember that fertility is a shared responsibility in couples. If your partner has not been assessed, both partners should undergo evaluation to identify any contributing factors and optimise the chances of conception.

Frequently Asked Questions