Wegovy (semaglutide 2.4 mg) does not directly enhance fertility through any pharmacological mechanism. However, the clinically significant weight loss achieved with this GLP-1 receptor agonist can indirectly improve fertility in individuals with obesity-related reproductive dysfunction. Excess weight disrupts hormonal balance, affecting ovulation, insulin sensitivity, and conception rates. When patients achieve substantial weight reduction—typically 10–15% of body weight—hormonal profiles often normalise, potentially restoring regular ovulatory cycles. Importantly, women of childbearing potential must use effective contraception throughout treatment, as improved fertility increases the risk of unplanned pregnancy. This article examines the relationship between Wegovy, weight loss, and reproductive health, alongside essential safety considerations for those planning conception.
Quick Answer: Wegovy does not directly increase fertility but may indirectly improve it through substantial weight loss that normalises hormonal balance in individuals with obesity-related reproductive dysfunction.
Wegovy (semaglutide 2.4 mg) does not directly increase fertility through any pharmacological mechanism. However, the substantial weight loss achieved with this medication can indirectly improve fertility in individuals with obesity-related reproductive dysfunction. There is no official link between semaglutide and enhanced fertility as a direct drug effect.
Weight loss and fertility connection: Obesity is associated with various reproductive disorders, including polycystic ovary syndrome (PCOS), anovulation, and reduced conception rates. Excess adipose tissue disrupts hormonal balance, affecting oestrogen metabolism, insulin sensitivity, and ovulatory function. When individuals achieve clinically significant weight loss (typically 5–15% of body weight), hormonal profiles often normalise, potentially restoring regular ovulation and improving fertility parameters.
Clinical trials of Wegovy have demonstrated average weight reductions of 10–15% over 68 weeks in the STEP clinical trial programme. For women with obesity-related infertility, this degree of weight loss may restore menstrual regularity and ovulatory cycles, thereby increasing the likelihood of conception. However, this represents an indirect consequence of weight reduction rather than a direct fertility-enhancing property of semaglutide itself.
Important safety consideration: Whilst weight loss may improve fertility, Wegovy should not be used during pregnancy and in women of childbearing potential not using contraception. The Medicines and Healthcare products Regulatory Agency (MHRA) advises that women of childbearing potential should use effective contraception throughout treatment. If fertility improves as a result of weight loss, unplanned pregnancy becomes more likely, necessitating careful contraceptive planning and regular pregnancy testing for sexually active individuals.
If you have been trying to conceive without success, the NHS recommends seeking GP advice after 12 months of regular unprotected intercourse, or after 6 months if the woman is aged 36 or older, or earlier if there are known fertility issues.
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Start HereWomen of childbearing potential must use reliable contraception throughout Wegovy treatment and for at least two months after discontinuation. This recommendation stems from limited human pregnancy data and animal studies suggesting potential foetal risk.
Contraceptive considerations: Patients taking oral contraceptives should be aware of important information. Wegovy delays gastric emptying, which theoretically could affect medication absorption. However, according to the UK SmPC for Wegovy, clinical studies have not demonstrated clinically relevant effects on the exposure of combined oral contraceptives. Therefore:
No specific timing adjustment between oral contraceptives and Wegovy injection is required
Routine additional barrier methods are not specifically required due to Wegovy
Long-acting reversible contraception (LARC) methods such as intrauterine devices (IUDs), implants, or depot injections remain unaffected by gastrointestinal absorption and may be suitable options
Importantly, if you experience vomiting or severe diarrhoea (potential side effects of Wegovy), this may reduce the effectiveness of oral contraceptive pills. Follow NHS guidance on missed pills if this occurs, and consider using additional contraception during and for 7 days after recovery.
Monitoring and patient counselling: Healthcare professionals should discuss contraceptive options before initiating Wegovy, particularly with patients who have obesity-related subfertility. As weight loss progresses, fertility may improve unexpectedly, increasing pregnancy risk. Regular consultations should include:
Assessment of contraceptive adherence and effectiveness
Pregnancy testing if menstrual irregularities occur or periods are missed
Clear advice to discontinue Wegovy immediately if pregnancy is confirmed or suspected
Patients should be informed that weight loss itself may restore fertility, making previously effective contraception insufficient if not used consistently.
Women planning pregnancy should discontinue Wegovy at least two months before attempting conception. This washout period allows semaglutide to be eliminated from the body, as the medication has a half-life of approximately one week, with steady-state concentrations achieved after 4–5 weeks of regular dosing.
Pre-conception planning: Ideally, pregnancy planning should involve a structured approach:
Discontinuation timeline: Stop Wegovy at least 8 weeks before planned conception attempts. This provides adequate clearance time and allows assessment of weight stability without medication.
Weight maintenance strategies: Work with healthcare professionals to establish sustainable dietary and lifestyle modifications to maintain weight loss achieved during treatment.
Nutritional optimisation: Begin folic acid supplementation (400 micrograms daily) as recommended by NHS guidance for pre-conception care. A higher dose (5 mg) may be recommended if you have diabetes, a BMI ≥30, take anti-epileptic medicines, or have a history of neural tube defects.
Medical review: Schedule a pre-conception consultation with your GP to review overall health, optimise management of comorbidities (diabetes, hypertension), and ensure any other medications are pregnancy-safe.
Unplanned pregnancy: If pregnancy occurs whilst taking Wegovy, discontinue the medication immediately and contact your GP or healthcare provider. Human data regarding semaglutide exposure during pregnancy are limited. Your healthcare team will arrange appropriate antenatal care and monitoring. Unintentional early exposure is not usually an indication for pregnancy termination, but individual assessment is advised. The UK Teratology Information Service (UKTIS) can provide healthcare professionals with risk assessment information.
Post-pregnancy considerations: Wegovy should not be used during breastfeeding, as it is unknown whether semaglutide passes into breast milk. Discuss post-partum weight management options with your healthcare provider after completing breastfeeding.
Wegovy's effects on reproductive health are primarily mediated through weight loss rather than direct hormonal manipulation. Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist that works by mimicking the incretin hormone GLP-1, which regulates appetite, glucose metabolism, and gastric emptying. GLP-1 receptors are found predominantly in pancreatic tissue, the gastrointestinal tract, and brain regions controlling satiety—not primarily in reproductive organs.
Indirect hormonal effects through weight loss: Substantial weight reduction achieved with Wegovy can significantly improve hormonal profiles in individuals with obesity:
Insulin sensitivity: Weight loss improves insulin resistance, a key factor in PCOS and anovulation. Reduced insulin levels decrease ovarian androgen production, potentially restoring normal ovulatory cycles.
Sex hormone-binding globulin (SHBG): Obesity suppresses SHBG production, increasing free testosterone and oestrogen levels. Weight loss normalises SHBG, improving hormonal balance.
Leptin and adipokines: Adipose tissue produces hormones affecting reproductive function. Weight reduction normalises leptin levels and reduces inflammatory adipokines that interfere with ovulation.
Oestrogen metabolism: Excess adipose tissue converts androgens to oestrogen, creating hormonal imbalance. Weight loss reduces this peripheral oestrogen production.
Clinical implications: For women with PCOS, weight loss can improve menstrual regularity and increase ovulation frequency, as recommended in NICE guideline NG194 for PCOS management. Some studies suggest improvements in male reproductive parameters following significant weight reduction, though evidence is mixed and individual responses vary.
Patients should be monitored for menstrual changes during Wegovy treatment, as restoration of regular cycles may indicate improved fertility and increased pregnancy risk without adequate contraception.
If you have concerns about fertility, the NHS recommends seeking GP advice after 12 months of trying to conceive (or 6 months if the woman is aged 36 or older), who can arrange appropriate investigations and referrals if needed.
Wegovy does not directly improve fertility, but the weight loss it produces may restore normal ovulation and hormonal balance in individuals with obesity-related reproductive dysfunction, indirectly increasing conception likelihood.
Yes, women of childbearing potential must use effective contraception throughout Wegovy treatment and for at least two months after stopping, as weight loss may unexpectedly improve fertility and increase pregnancy risk.
You should discontinue Wegovy at least eight weeks before attempting conception to allow adequate clearance of semaglutide from your body and to establish weight maintenance strategies.
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