Melanie Cole, MS (Host): Are you thinking about trying for a baby, but you're concerned about your weight? Do the weight loss medications that we hear about on the market, like Ozempic, do they help you or can they hurt you? We're going to talk about that today on Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey.

I'm Melanie Cole and joining me as always is Dr. William Ziegler. He's a Specialist in Reproductive Endocrinology and the Medical Director of the Reproductive Science Center of New Jersey.

Dr. Ziegler, thank you so much for joining us today. Can you explain the relationship as we get into this topic between weight and fertility? Where do they intersect?

William Ziegler, MD: Well, I think there's two things we have to talk about. Those that are underweight and those that are overweight. When someone is underweight, like a, just an athlete or a gymnast or somebody who likes doing a lot of aerobics, if their body fat is not to a certain point, what can happen is it can throw off their hormones.

Their body reads that as being malnourished and basically will shut down their reproductive system because the body senses that they can't take care of themselves and take care of a pregnancy. We see this when the body mass index is less than usually 19. And at that time, a lot of women are put on birth control pills to regulate their cycles because they're not getting them.

In those patients, we counsel them prior to getting pregnant is to actually gain some weight and increase their body fat percentage. And then we have those that are overweight. When you talk about being overweight, we're talking maybe a body mass index, which is over just 27 or 28.

That's where it starts getting into the overweight category. And in that situation, there is a lot of, peripheral tissue. And a lot of times this is linked to what's called insulin resistance. And that can again throw off a woman's cycle, cause some hormonal abnormalities. And even in pregnancy, those patients that are overweight have a higher incidence for having pregnancy losses.

 Again, inability to get pregnant because their cycles are now thrown off because they have, too much peripheral tissue. So it's kind of like a see saw effect. You have to find what is perfect for that individual.

Host: Well, thank you for that. And we are learning more about that relationship between weight and fertility. And while we're talking about people that are overweight, that have issues in that respect, there's so many things on the market now, Dr. Ziegler. Tell us a little bit about semaglutide, or Ozempic as it's known.

We hear about it in the media. How do we relate that to weight management and fertility? Does it help or hurt? Tell us about that.

William Ziegler, MD: Well, I think it, back in the day, when people were failing dieting, and they could not lose the weight, then they went to surgical intervention. The gastric bypass, the band. So, and in those situations, the recommendation is after that surgery is to wait a year and a half prior to getting pregnant.

But a lot of these women want to get pregnant quicker. And that is where these weight loss medications have come onto the market. And even though they are specifically designed for treating diabetes, it has been linked to helping people get pregnant. It really comes from two standpoints, that by losing the weight, you lower insulin and therefore you improve the hormonal environment and can allow women to ovulate all on their own, specifically those like polycystic ovarian syndrome patients. The stigmata is they are overweight. And if they lose that weight, their cycles can come back on naturally. There's also been reports where women are on birth control pills and they're put on Ozempic and they're conceiving mainly because it decreases the motility of the GI tract and therefore the birth control pills are not absorbed in the proper fashion and therefore women are getting pregnant on Ozempic.

Now there's been animal reports that have shown that if somebody gets pregnant on Ozempic, or within two months of stopping Ozempic, that there are some effects that can occur, like growth retardation as well as some other type of abnormalities. So, I think these medications in which they do have a role, but I think they could be being overused.

For our patients that want to get into fertility treatment, and for us, our body mass index cutoff is 45, and if you're over 45, we usually don't recommend getting pregnant until your body mass index is less than that. Just mainly because of increased risk of miscarriage or fertility treatment does not work, as well as if we're going for IVF, it makes it harder to see the ovaries if somebody is overweight.

So in those cases, some patients will take the Ozempic or those medications for just one or two months, just to get their body mass index in the appropriate range that we can help them get pregnant.

Host: Wow. You just gave us so much information, Dr. Ziegler, so much that I didn't know. I just learned a lot. And I find it so interesting to learn about really the actions of a medication and that gastrointestinal motility and how they're working that makes so much sense now. So what advice would you give a woman when you say that 45 is kind of where you would tell patients not to get pregnant, to try and lose the weight first?

What advice would you give somebody who is under 45 BMI, who is considering using the semaglutide or Ozempic, and saying, well, what should I do with this?

William Ziegler, MD: Well, I think it also comes down to their age and how long in which they've been trying to get pregnant. And then we go through the pros and cons. Yes, it's going to be better if they do lose the weight. And if, the oral medications will help them do that quicker, then it may be of benefit to them because you also have a psychological component to this also, which basically a lot of women have been trying to get pregnant or they're struggling with their weight and they, and their cycles are markedly irregular and they're getting quite frustrated.

So by using the medications for, for just a short term, one month or two months also helps them psychologically prepare to go through the fertility process and makes it a better outcome for them. And they're actually doing something that's going to help them even from a health maintenance standpoint because that's the other part of this.

Once you lose the weight, you have to be able to keep it off. And that means you have to change your diet, you have to change your exercise routines. So it is going to be a life changer, but sometimes losing that weight helps you make that change easier. It's easier to go to the gym. You're not as exhausted.

So as I said, I don't think it's a longterm, use medication. I don't think it is the silver bullet that people think it is, but I think it can help an individual maybe get to that point where they can do exercise, they feel good about themselves, and in which their whole outlook on life is better.

Host: As we wrap up, Dr. Ziegler, as we think about those management strategies that you were discussing, exercise and lifestyle going hand in hand with Ozempic and weight loss strategies, tell us a little bit about any alternative weight management strategies that you recommend if somebody says they're a little nervous about the medications or they're not ready for bariatric or they don't weigh enough for that.

What are some of great things that you tell people when you talk about exercise and diet? There's got to be some specifics there, right? So why don't you end this podcast today with really your best advice as far as lifestyle and trying to get a handle on that.

William Ziegler, MD: I think getting into a balanced diet. One that maybe requires a nutritionist to help guide you because everybody's diet is different. So therefore, and then if you're vegan or if you are a vegetarian or you eat the Mediterranean diet, okay, those are fine. However, you need to make sure it is balanced.

And I think that is where a nutritionist would come into play. I also think that regular exercise is important. A sedentary lifestyle is not, that it doesn't bode well. So therefore having some exercise, even going out and just walking for 20 minutes or 30 minutes a day, something like that can, again, can really be beneficial for you.

But when it comes down to weight loss, you really need to take a look at the patient's diet. You have to take a look at what they normally do as well as the work they do. Some people are very active at work. But again, the activity they're doing at work is not really advancing their well being. And that's where getting someone and just even a trainer, to help isolate, what do you need to help you feel better?

Host: Do you have any final thoughts on Ozempic itself as we just are hearing so much conflicting information and the fertility specialist that you are?

William Ziegler, MD: Before you jump on the Ozempic bandwagon, I think you really need to take a look at your diet and as well as your exercise and maximize those things. And then still, if you're still unable to get to the appropriate body mass index or lose weight, then it is time to think about some other medications as well as being screened for other disorders, such as insulin resistance, such as hyperandrogenism, which again, can make you gain weight. So those are some medical conditions that should be treated prior to considering a surgery or even medication to lose weight.

Host: You're such a great guest as always, Dr. Ziegler and a great educator, thank you so much for joining us today and for more information, you can visit fertilitynj.com to get connected with one of our providers. That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey.

I'm Melanie Cole. Thanks so much for joining us today.