What does the data reveal about how long you should be off GLP-1 medications before getting pregnant?
—Ready to Swap GLP-1 for Gestation
GLP-1 agonists are safe and effective treatments for Type 2 diabetes and obesity. As you know if you have been anywhere on the internet in the past few years, they have become immensely popular. However, they have not been studied in pregnancy, so we currently recommend stopping them prior to becoming pregnant.
If you get pregnant unexpectedly while taking a GLP-1 agonist, don’t panic. There is no evidence that these medications are unsafe in pregnancy; they just aren’t well studied in pregnancy. Similarly, there are no guidelines or data regarding when to stop taking a GLP-1 prior to trying to conceive. While we may someday get guidelines, we are unlikely to get good data. Instead, I rely on pharmacokinetics — how drugs are metabolized by our body — to make an educated decision on when to stop GLP-1 agonists prior to pregnancy.
The most popular versions of these medications — semaglutide and its cousin tirzepatide, sold under the brand names, respectively, Ozempic and Wegovy, Mounjaro and Zepbound — are given once weekly, which means they circulate in your bloodstream for about seven days. In fact, the half-life of semaglutide — how long it takes for blood levels of the drug to decrease by one-half — is seven days. The half-life of tirzepatide is about five days.
A basic rule of thumb in pharmacology is that it takes four to five half-lives for a drug to go from a concentration of zero in the blood to steady-state, and conversely it takes four to five half-lives for a drug to go from steady-state to a concentration of essentially zero. For semaglutide, four to five half-lives is 28 to 35 days. For tirzepatide, it would take less time, just 20 to 25 days.
The most cautious approach would be to take your last dose five half-lives before the menstrual period after which you plan to try to conceive. Following this plan, you could be assured that your blood level of the medication would be essentially zero when the egg you will ovulate mid-cycle begins to mature.
If you are taking a GLP-1 agonist as treatment for Type 2 diabetes, be sure to work with your doctor to develop a medication regimen that adequately controls your blood sugar and is safe in pregnancy. Excellent glucose control is critical for healthy fetal development. If you are taking a GLP-1 agonist as part of a medical weight loss program, it can be helpful to make a plan with your doctor to help you maintain your weight while you are trying to conceive.
Ultimately, there is very little guidance regarding when to stop GLP-1 agonists prior to trying to conceive, but based on the half-life of the most commonly used GLP-1 agonists, stopping about five weeks prior to the menstrual period before you would like to conceive should be sufficient.
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There’s lots of reports of ozempic increasing fertility rates. For those unsuccessfully TTC, would using Ozempic make sense before going the IVF route?