GLP-1s and fertility: trying to conceive

The most important thing, first

If there is one thing to take from this whole page, it is this: GLP-1 medications are not used during pregnancy, and you are meant to stop them before you conceive — not the day you find out. There is a planned window for coming off, and there are a couple of things about birth control and fertility that genuinely catch women off guard. I will walk you through all of it warmly and honestly, so you can plan instead of worry.

Why you stop before, not during

GLP-1 medicines are not recommended in pregnancy, and guidance for women of reproductive age is to discontinue them ahead of a planned pregnancy rather than continuing until a positive test¹. Because these are long-acting medicines that linger in your system, manufacturers advise stopping a set time before trying to conceive so the medication has cleared — a washout window your clinician will pin to your specific drug and dose¹. The practical takeaway: if a baby is the plan for this year, coming off the medication is part of the plan, and it is a conversation to have early.

The part that comes after you stop

There is a newer finding here worth knowing about. A 2025 study matched 448 pregnancies in which a GLP-1 had been prescribed — any time in the three years before conception, or in the first weeks after — against 1,344 otherwise similar pregnancies with no such prescription. The GLP-1 group gained more weight during pregnancy, 13.7 kg on average against 10.5 kg, and had somewhat higher rates of preterm birth, gestational diabetes and high blood pressure in pregnancy². Please read that as a pattern rather than a cause. Eighty-four percent of the exposed women were living with obesity before pregnancy, and that alone moves every one of those numbers. What it does tell you is that the stretch after you stop deserves its own plan, not just the stopping itself. Ask what happens to your appetite and your weight in those months, and who is watching them with you.

What if a pregnancy happens unexpectedly?

First — breathe. If you become pregnant while on a GLP-1, the guidance is to stop the medication and contact your clinician promptly, not to panic¹. The reassuring context: a large study of early-pregnancy exposure to GLP-1 medicines did not find a clear signal of major birth defects compared with other diabetes treatments³. That is genuinely comforting, though it is not the same as these drugs being approved or recommended in pregnancy — they are not. The honest summary is "an unplanned exposure is not a cause for panic, and you stop and call your clinician."

The birth-control detail nobody warns you about

Here is one that surprises a lot of women: with tirzepatide specifically, the medication can reduce how well oral birth control works, and additional or non-oral contraception may be advised for a stretch when starting or increasing the dose⁴. If you are on a GLP-1 and not ready to conceive, this is exactly the kind of thing to raise with your clinician so you are not caught out. Please do not treat "I'm on a weight medicine" as "I can't get pregnant" — for some women, the opposite quietly becomes true.

The flip side: GLP-1 medicines and improved fertility

This is the hopeful part. For many women, especially those with weight-related or PCOS-related fertility challenges, losing weight and improving metabolic health can support more regular ovulation and conception⁵. GLP-1 medicines drive real weight loss⁷, and reviews describe them as a promising avenue for supporting fertility in women with obesity and PCOS⁸ — with early reports of higher spontaneous conception rates when GLP-1 therapy is used before a fertility treatment cycle rather than during pregnancy⁴. So the arc that helps many women is: use the medicine to reach a healthier metabolic starting point, then step off it under guidance and try to conceive. It is a bridge, not a companion for the pregnancy itself.

How to actually plan this

The clean version of a plan looks like: talk with your clinician about your timeline, agree on when to stop the medication and how long to wait, sort out reliable contraception for the in-between (especially on tirzepatide), and go into trying-to-conceive medication-free. Reviews of medical therapy for fertility keep landing on the same point — any plan like this is only as good as the clinician steering it for your body⁶, so lean on that relationship. If you are still deciding whether a GLP-1 fits you at all, is GLP-1 right for me? is a gentle place to start.

A warm next step

If you are weighing a GLP-1 with motherhood on the horizon, the right first move is a clinician who will map the stop-and-try timeline with you. If PCOS is part of your fertility story, can GLP-1 help PCOS? is worth reading next. You are allowed to plan this carefully and kindly. — Camila