Latest article: GLP-1 receptor agonists: Implications for PCOS, fertility and contraception

Glucagon-like peptide receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide receptor agonists (GIP RAs) are widely known for their benefits for management of obesity and type 2 diabetes (T2DM). More recently GLP-1 RAs have gained popularity and been studied for enhancing fertility and improving pregnancy rates in women with obesity and polycystic ovarian syndrome (PCOS).^1,2 While Ozempic is the most recognised GLP-1 RA, other GLP-1/GIP RAs are also available in Australia (see Table 1). Given the widespread use of these medications, allied health practitioners need to work safely and collaboratively with patients to optimise fertility outcomes as well as prevent nutrient deficiencies and rebound weight gain.

GLP-1 AND GIP: A POTENTIAL ROLE INFERTILITY?

Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are natural incretin hormones secreted by the cells within the gastrointestinal system after ingestion of food.¹² They function by stimulating the pancreas, improving insulin secretion and inhibiting glucagon secretion, supporting glucose homeostasis.¹³ While GLP-1 receptors are abundant in the pancreas, they are also found in the hypothalamus, pituitary, and reproductive organs such as the uterus and ovaries,¹³ highlighting their role within the female reproductive system, particularly in conditions where disordered glucose metabolism is involved, such as in PCOS.¹⁴

Obesity and blood sugar dysregulation may impair reproductive function.15 While nutrition and lifestyle interventions are first line management strategies to counteract both obesity and poor blood glucose control, many individuals struggle to lose weight solely by implementing these strategies.¹⁶ Subsequently, combining diet and lifestyle strategies with pharmacotherapy such as GLP-1 RAs and GLP-1/GIP RAs may be a more effective strategy for promoting weight loss.^1,16