Obesity and Female Reproductive Health; Is There a Role for Glucagon-Like Peptide-1 Receptor Agonists?

Abstract

Women with a raised body mass index are likely to take longer to conceive and have poorer outcomes from fertility treatment. Furthermore, fertility clinics commonly require women to have body mass index < 30 kg/m² prior to treatment. Consequently, many women face the challenge of needing to lose weight to improve their chances of conception or to become eligible for fertility treatment. For these women, there is an additional pressure to lose weight quickly due to the diminishment in reproductive potential with advancing age. Synthetic glucagon-like peptide-1 receptor agonists have been shown to cause rapid weight loss in individuals with obesity, as well as reversing some of the metabolic dysfunction associated with obesity and polycystic ovarian syndrome. The potential effect of preconception glucagon-like peptide-1 receptor agonist therapy to increase the chance of pregnancy in women with obesity is an emerging area of research. If this treatment proves to be safe and effective, it could provide significant benefits for many overweight women facing infertility. This article summarizes our understanding of the effect of obesity and polycystic ovarian syndrome on fertility and the success of assisted reproductive techniques. It also describes the traditional treatments for obesity, the pharmacology of glucagon-like peptide-1 receptor agonists, and the evidence for glucagon-like peptide-1 receptor agonists in improving fertility and pregnancy outcomes in overweight women, as well as the potential safety and ethical issue.