She had a history of polycystic ovarian syndrome and had gotten hold of some Ozempic locally.

It had worked and she had lost tens of pounds, when because of her PCOS, she had struggled to do so before. She was on the Combined oral pill, and her last withdrawal bleed was lighter than usual…that coupled with the fact that she had heard about the “Ozempic baby” phenomenon” made her suspicious, so she did a pregnancy test..Positive. I have to admit she taught me something… as so often my patients do, as I had not heard of this phenomenon myself.

So, what had happened here? Why are women getting pregnant when they don’t expect to on Ozempic?

Well, there are many theories.

The most obvious one is that being overweight reduces fertility, especially in women with PCOS – so weight loss improves fertility. This is why we encourage women who are overweight to lose weight with PCOS.

The second possibility is that Ozempic is interfering with the pill in some way. To understand this, we have to look at how Ozempic works. The active ingredient is Semaglutide. Semaglutide is the same drug that is in Wegovy. Ozempic is licensed for Diabetes and Wegovy for weight loss…but they are pretty much the same thing. They belong to a class of drugs called Glucagon Like Peptide agonists. (GLP1 agonists). There are GLP1 receptors all over the body. In the brain, they act to make you feel fess hungry. In the gut, they reduce gastric emptying and make you feel fuller for longer. They work to lower blood sugar levels by helping Insulin release. Now, it could be that the reduced gastric emptying is affecting the way the pill is absorbed from the gut. Or, perhaps, the nausea and vomiting that is sometimes associated with Ozempic has made women vomit up their pill before it is absorbed. It may also be that Ozempic is inhibiting the action of the pill in some way- we know for example that there are GLP1 receptors in the ovary, and in fact on the testes too. Could it be that Ozempic is inhibiting the ability of the contraceptive pill to stop ovulation?

The GLP receptors on the ovary and testes could also mean that Ozempic is somehow stimulating these sex organs to work better anyway.

The message: If any of you are on Ozempic/Wegovy or any other GLP 1 receptor agonist and you do not want to be pregnant, make sure you use condoms…. And, if you do become pregnant on Ozempic you should probably stop it. Not because we know for sure it is harmful in pregnancy in any way, but just because we do not know if it is not…and no, I would not recommend using GLP1 receptor agonists to become pregnant yet for exactly this reason! Although, if later down the line research does show that it can be used in this way it will add to the myriad of miracles this drug seemingly performs: Not just Diabetes control and weight loss, but also reduction in Cancer risks and cardiovascular disease. All of this from a protein found in the ugly (or beautiful depending on who is looking,) fella in the picture above. He is called a Gila monster and it’s from his venom that the original Ozempic was discovered. . Don’t worry, Semaglutide is now manufactured in yeast cells engineered to produce it in a lab, so no monsters are being harmed in the production of this drug now…

There are, however, some disadvantages too: There are not only Ozempic babies, but also something called “Ozempic face”

There is something else to consider too: Wegovy/Ozempic is not officially available in TT. So, if you do find it locally it has probably been brought in by a suitcase trader. There are two problems with this:

1. You cannot be sure that this is not a fake drug… and there is a huge market in this for fake GLP 1 agonists in particular because there is a worldwide shortage of the drug: Supply has not been able to keep up with demand. It is also an expensive drug so the profit margins can be huge if they are selling you saline instead of an active drug. There are also “compounded” versions of the drug which are not FDA approved and are of varying quality/safety.

2.These drugs need to be kept in cold storage and if people are bringing them in their suitcases, we are not sure if this cold chain is being preserved. This means that even if the drug is real, it may not work properly. I have certainly seen this happen with another one of my patients who procured some Ozempic from a pharmacy. It did not harm him, but it just did not work. Unusual, which makes me wonder if point 1 or 2 applied in his case.

Whatever you think of the suitcase trade, either dangerous or fulfilling a need, I think we also have to ask ourselves why people are going to such measures and taking such risks. Forget Ozempic: people are being forced to resort to travel abroad or suitcase traders more and more to get some fairly basic drugs now. We need to ask ourselves what is behind such desperation and what needs to be done to increase drug availability here.