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GLP-1 Receptor Agonists and Fertility: What Is Known So Far?
Alice Scalzilli Becker1,2, Júlia Prauchner de Castilhos1, Sophia Abur Said Shugair1
1School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
JBRA Assisted Reproduction
|July 13, 2026
Summary
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) show promise for improving fertility in women with polycystic ovary syndrome (PCOS). These weight loss medications enhance metabolic and reproductive outcomes, particularly when combined with metformin, but are not recommended during pregnancy.
Area of Science:
- Reproductive Endocrinology and Infertility
- Metabolic Syndrome and PCOS Management
- Pharmacological Interventions in Women's Health
Background:
- Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with infertility and metabolic dysfunction.
- Obesity frequently exacerbates PCOS symptoms, negatively impacting fertility and increasing the need for effective weight management strategies.
- Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are emerging as therapeutic options for weight loss and metabolic improvement.
Purpose of the Study:
- To review the current literature on the efficacy of GLP-1 receptor agonists (GLP-1RAs) as an adjunct therapy in preconception care for women with PCOS and infertility.
- To evaluate the impact of GLP-1RAs on metabolic and reproductive outcomes in women with PCOS.
- To assess the safety and contraindications of GLP-1RAs in the context of fertility treatment and pregnancy.
Main Methods:
- A narrative literature review was conducted using PubMed, SciELO, and LILACS databases.
- Search terms included "weight loss medication," "GLP-1 receptor agonists," "liraglutide," "semaglutide," "fertility," "PCOS," and "reproductive outcomes."
- Studies published between 2014 and 2025 were included, resulting in the analysis of 47 relevant articles.
Main Results:
- GLP-1RAs demonstrated consistent metabolic benefits and emerging evidence of improved reproductive outcomes in women with PCOS.
- Clinical trials reported increased menstrual regularity, ovulation rates (up to 86% with exenatide plus metformin), and pregnancy rates (69.2% with liraglutide plus metformin).
- GLP-1 receptors are present in reproductive tissues, suggesting direct effects via anti-inflammatory, antifibrotic, and androgen-lowering mechanisms.
Conclusions:
- GLP-1RAs represent a promising strategy for preconception management in women with PCOS and obesity-related infertility, especially when combined with metformin.
- These agents are contraindicated during pregnancy due to limited human data and observed fetal risks in animal studies.
- Individualized counseling is crucial, considering the need for a washout period (8-10 weeks for semaglutide/tirzepatide) and potential interactions (e.g., tirzepatide with oral contraceptives).
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