Source: Professional review / social media publication by Madonna Jugheli
In modern medicine, GLP-1 (an incretin hormone) and GLP-1/GIP receptor agonist therapy is one of the most widely discussed, revolutionary, and topical areas. However, along with growing interest and popularity, misinterpretations and misconceptions have also increased.
Evidence-based medicine means not only stating what has already been proven, but also honestly acknowledging those issues that are still under active investigation. The following review discusses all major aspects of the therapy, from its mechanism of action to its potential impact on reproductive health.
What is GLP-1/GIP therapy?
GLP-1 and GLP-1/GIP therapy refers to a new class of medications that mimic the action of hormones naturally released in our body (in the intestines) after food intake. These medications regulate blood glucose levels, slow gastric emptying, and reduce appetite by acting on the hunger center in the brain.
The best-known medications in this group today include semaglutide (brand names: Ozempic, Wegovy), liraglutide (Saxenda), and the dual-action agent tirzepatide (Mounjaro, Zepbound). These medications are generally administered once daily or weekly as subcutaneous injections using a specialized pen and are prescribed under the supervision of an endocrinologist.
- What do we know for certain?
Confirmed evidence
GLP-1 (Glucagon-like Peptide-1) and GIP (Glucose-dependent Insulinotropic Polypeptide) are incretin hormones naturally released by the intestines after food intake. Pharmacological therapy enhances these hormonal pathways and provides:
- Glycemic control: stimulation of glucose-dependent insulin secretion, suppression of glucagon, and effective reduction of HbA1c (glycated hemoglobin).
- Appetite and satiety regulation: suppression of the hunger center in the central nervous system (hypothalamus), delayed gastric emptying, and prolonged feelings of fullness.
- Cardiovascular protection: clinically demonstrated positive effects in reducing the risk of cardiovascular disease and improving endothelial function.
- The Role of GLP-1/GIP Therapy in Reproductive Medicine
One of the most important and promising areas currently attracting the attention of the scientific community is the potential impact of this therapy on female and male reproductive health.
Is GLP-1 a “fertility drug”?
No – not in a direct or definitive sense.
GLP-1/GIP medications:
- ❌ are not standard medications for ovulation induction;
- ❌ do not replace letrozole or other approved reproductive treatments;
- ✔️ may help selected patients improve their metabolic health before pregnancy.
Its role is more accurately defined as preconception metabolic preparation in patients with overweight/obesity and PCOS (polycystic ovary syndrome).
Polycystic Ovary Syndrome (PCOS)
PCOS is closely associated with insulin resistance, hyperinsulinemia, and excess weight. GLP-1/GIP therapy may improve insulin sensitivity, reduce androgen levels, and help restore ovulatory cycles.
Improving fertility
Improving the metabolic profile and reducing body weight can directly affect ovulation frequency and egg quality, potentially increasing the chances of natural conception as well as success with assisted reproductive technologies (IVF).
Male reproductive function
In cases of obesity- and metabolic syndrome-associated hypogonadism, improving weight and metabolic health may have a positive effect on testosterone levels and spermatogenesis.
Important warning during pregnancy
Despite potentially positive effects on fertility, GLP-1/GIP medications are contraindicated during pregnancy and breastfeeding. Before planning pregnancy, the medication should be discontinued for an appropriate period as determined by a physician, typically several weeks to months beforehand.
- When Does the Therapy Have Clear Benefits?
Indications
- Type 2 diabetes mellitus: for optimal glycemic management.
- Overweight and obesity: BMI ≥ 30 kg/m², or BMI ≥ 27 kg/m² in the presence of associated metabolic or cardiovascular complications.
- Metabolic syndrome and fatty liver disease (MASLD/MASH): with the aim of improving insulin resistance and reducing visceral/adipose tissue.
- Questions for Which Sufficient Evidence Is Not Yet Available
In medicine, it is essential to clearly distinguish between established facts and issues that remain under investigation. At present, the following areas are still being studied:
- Long-term effects in non-diabetic populations: the complete long-term safety profile of medications used solely for weight management.
- Weight maintenance after discontinuation: strategies to prevent patients from regaining weight – the so-called “rebound” effect – after treatment ends.
- Use in other conditions: the potential role of these medications in treating neurodegenerative diseases, such as Alzheimer’s and Parkinson’s disease, and other endocrine disorders. Research is ongoing, but definitive recommendations have not yet been established.
“Evidence-based medicine means not only stating what we already know, but also honestly acknowledging what is still under investigation.”
– Madonna Jugheli
Conclusion
GLP-1/GIP therapy represents one of the major achievements of modern endocrinology and metabolic medicine, with potentially far-reaching positive effects, including on reproductive health.
However, it is not a “magic wand.” Treatment initiation, dose titration, and ongoing management should be carried out only under medical supervision, taking into account individual indications and alongside a healthy lifestyle.