How GLP-1 Weight Loss Drugs Affect Fertility, Ovarian Function, and IVF Outcomes

GLP-1 receptor agonists directly affect ovarian biology — not just through weight loss, but by acting on ovarian cells themselves. In women with PCOS, these drugs improved menstrual regularity, reduced free testosterone, and increased sex hormone-binding globulin. Liraglutide combined with metformin significantly improved IVF pregnancy rates, while exenatide increased natural conception rates. At the molecular level, GLP-1 receptor activation promotes granulosa cell growth through FOXO1 signaling and modifies steroid hormone production by suppressing key steroidogenic enzymes. However, animal studies raised concerns about potential ovarian and uterine damage at certain doses, including oxidative stress, granulosa cell death, and uterine inflammation.

Systematic review following PRISMA guidelines, searching PubMed, Scopus, and Web of Science for randomized trials, prospective studies, animal models, and cellular experiments evaluating GLP-1 receptor agonist effects on reproductive or ovarian outcomes. Data included metabolic changes, androgen levels, menstrual regularity, ovarian structure, granulosa cell biology, signaling pathways, and fertility/IVF outcomes.

Millions of women of reproductive age now take GLP-1 drugs, and many have PCOS — a condition where these drugs are increasingly used. This review reveals that GLP-1 drugs do far more than just help with weight loss; they directly influence ovarian function, hormone production, and fertility at the cellular level. The finding that liraglutide improved IVF success rates is clinically significant, but the animal data showing potential ovarian damage raises important safety questions that need answers.

As GLP-1 drugs become the most prescribed medications for obesity and diabetes, understanding their effects on fertility is critical. This review shows these drugs have direct biological effects on the ovaries that go far beyond weight loss — they modify hormone production, cell survival, and follicle development. For the millions of reproductive-age women now taking these drugs, this research highlights both opportunity (improved fertility in PCOS) and concern (potential reproductive toxicity) that demand urgent clinical investigation.

Most clinical evidence comes from women with PCOS, so findings may not apply to women without PCOS. Animal studies showed contradictory results (both beneficial and harmful), suggesting dose and context matter significantly. The review acknowledges limited understanding of the molecular mechanisms and calls for controlled human research to clarify reproductive safety, particularly in non-PCOS populations and IVF settings.