Published Jun 28, 2026 | 7:00 AM ⚊ Updated Jun 28, 2026 | 7:00 AM
GLP-1 drugs. (iStock)
Synopsis: Fertility clinics across India are increasingly using GLP-1 drugs in women with obesity, PCOS and insulin resistance before conception. While specialists see them as a promising tool for metabolic optimisation and improving reproductive readiness, others caution that evidence remains limited, long-term effects are unclear, and nutritional concerns need closer attention.
Doctors across India are increasingly using GLP-1 drugs in women with obesity, PCOS and insulin resistance before conception. Supporters see a promising tool for metabolic optimisation, while critics say the evidence remains incomplete.
Two years ago, a woman with obesity and PMOS arriving at a fertility clinic would likely have received the same advice repeated at every prior appointment: lose weight through diet and exercise, then return. The path to IVF began when she crossed a body weight threshold. The waiting happened outside the clinic.
That is changing. Fertility specialists across India are now using GLP-1 receptor agonists, a class of drugs used to treat obesity and diabetes, as part of structured pre-conception care. A new phase of treatment is emerging, one that begins months before conception is attempted. Some specialists call it metabolic preparation. Others call it reproductive readiness. The idea is the same: the fertility runway now starts earlier, and for some patients, it starts with a weekly injection.
Not every specialist agrees the runway is ready.
“We are not using semaglutide right now because it is a new drug and we need more studies to confirm there are no long-term side effects,” says Dr Shalini Singh, Fertility Specialist at 9M Fertility by Hyderabad based Ankura Hospital to South First. “We do not know what the impact will be on these women after ten years.”
Her position reflects a genuine division in Indian fertility medicine. On one side, clinics including Indira IVF, Oasis Fertility, Fortis Hospital and Gleneagles BGS Hospitals have folded GLP-1 drugs into pre-conception protocols for selected patients. On the other, specialists such as Dr Shalini hold that the evidence has not caught up with the practice. Both sides are responding to the same clinical reality.
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India carries a metabolic burden that fertility specialists cannot ignore.
The country is home to over 100 million people with type 2 diabetes, the second largest affected population in the world. An estimated one in five women of reproductive age carries a diagnosis of polycystic ovary syndrome. Obesity rates among urban women have climbed sharply over the past decade, driven by sedentary work, dietary shifts, and a genetic predisposition to insulin resistance that expresses earlier and more aggressively than in many Western populations. Women are also delaying childbearing, and metabolic conditions accumulate with time.
These conditions share a mechanism in the fertility context. They disrupt ovulation, suppress reproductive hormones, raise the risk of miscarriage, and reduce the probability of conception. A specialist treating a woman with obesity, PCOS, and insulin resistance is not treating one problem. She is treating a cluster that sits upstream of fertility treatment itself.
GLP-1 receptor agonists work on that cluster at its metabolic root.
Nitiz Murdia, managing director of Indira IVF Hospital, describes a practice that now begins months before a patient enters an IVF cycle. “We are selectively using GLP-1 receptor agonists in women with obesity, PCOS, insulin resistance, or metabolic syndrome as part of pre-conception and pre-IVF metabolic optimisation,” he says to South First. “Their use is individualised and aimed at helping patients enter pregnancy in the best possible health.”
Women with PCOS often spend years moving between diet plans, exercise programmes, metformin prescriptions, and fertility consultations. For some, meaningful weight loss remains frustratingly difficult. “These medications are not fertility drugs in themselves,” Murdia adds, “but by improving weight and metabolic health, they can help address factors that negatively impact ovulation and reproductive outcomes.”
Dr Srinivasa Varalakshmi Yakasiri, regional medical head at Oasis Fertility in Hyderabad, places the shift in historical context. “Previously, there were very limited weight management interventions: diet, exercise, and bariatric surgery,” she says to South First. “They are becoming an important part of preconception care.” Use has grown noticeably over the past two to three years as both awareness and early evidence have accumulated.
The runway concept changes how fertility care is sequenced. A woman does not wait outside the clinic until she loses weight independently. She enters a structured pre-conception phase, managed jointly by a fertility specialist and often an endocrinologist, with a defined metabolic target and a defined timeline. When she meets both, conception planning begins. Clinical practice is evolving ahead of long-term data, but the biological rationale is gaining ground.
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Dr Shalini refers patients with obesity and metabolic dysfunction to endocrinologists rather than prescribing GLP-1 drugs herself. “Gynaecologists can prescribe these medications, but we need more evidence before they can be used routinely,” she says. “At present, semaglutide is not a first-line treatment for women with obesity, PCOS or diabetes in fertility practice.”
Her concern extends beyond adoption rates. “For diabetes, we already have first-line treatments such as metformin and other medicines that work well,” she says. The clinical case for adding a newer, less-studied agent requires stronger justification than enthusiasm and early data.
She draws a comparison that carries weight. Bariatric surgery has been available for decades for severely obese patients and has never become routine in fertility care. “I do not think semaglutide will become a routine drug in fertility practice,” she says. “There are also no long-term studies. We do not know what the impact will be on these women after ten years. That is another reason why caution is needed.”
The specialists who prescribe do not dispute that fertility-specific evidence remains limited. They argue that the metabolic rationale is sufficiently robust to justify selective use now, while research matures. The gap between those two positions is where current practice lives.
Fertility clinics did not create the demand for these drugs. The demand arrived on its own.
Social media, celebrity endorsements, and global coverage of GLP-1 therapies for weight loss have produced patients who name specific drugs before a doctor raises the subject. “Awareness around GLP-1 receptor agonists has increased substantially, driven by media coverage, social media discussions, and celebrity endorsements,” says Murdia. “Many patients are now proactively asking about these medications when they seek fertility care.”
Dr Manisha Singh, additional director and reproductive medicine sub-specialist at Fortis Hospital in Bengaluru, observes the same shift. “Many patients are aware that weight and metabolic health can affect fertility and want to know whether these treatments may help them improve their chances of conception,” she says to South First. “Social media, celebrity endorsements, and increased media coverage have also contributed to growing public interest.”
Specialists must now counsel patients whose expectations have been shaped by weight-loss headlines rather than reproductive medicine data. “It is important to explain that these medicines are not suitable for everyone and should only be used under medical supervision,” says Singh. Managing the distance between public enthusiasm and clinical evidence has become part of the consultation itself.
The distinction every prescribing specialist reaches for is the same, and it matters because the public narrative around these drugs consistently blurs it.
GLP-1 receptor agonists promote weight loss and improve metabolic health. In women with PCOS, these changes can restore menstrual regularity and ovulation. They reduce the procedural risk of IVF by lowering body weight before anaesthesia and stimulation.
What they do not do, at least not with sufficient evidence, is improve egg quality, embryo quality, or IVF success rates directly.
Dr Annapureddy Kumari, fertility specialist at Oasis Fertility, holds this line clearly. “The main goals are weight reduction, improved insulin sensitivity, better metabolic health, and restoration of ovulation in women with PCOS,” she says to South First. “While some studies suggest improvements in reproductive outcomes, robust evidence for direct improvement in egg quality or IVF success rate is still evolving.”
Dr Singh is equally measured. “The primary goals are weight loss, improved insulin sensitivity, and better metabolic health,” she says. “While early findings are encouraging, more research is needed to confirm the direct impact on egg quality and IVF success rates.”
Fertility specialists are adopting these therapies before fertility-specific evidence has fully matured. The biological rationale is stronger than the outcome data. That gap is the story inside the story.
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The drug that prepares the body for pregnancy must stop before pregnancy begins.
GLP-1 receptor agonists have long half-lives and remain in the body for weeks after the last dose. Given the near-total absence of safety data on these drugs during pregnancy, every prescribing specialist applies the same rule: discontinue at least two months before attempting conception or embryo transfer.
“Current recommendations suggest discontinuing semaglutide at least two months or eight weeks before attempting conception because of its long half-life,” says Dr Kumari. “There is currently no universal fertility-specific guideline regarding the timing before ovarian stimulation, but most clinicians prefer discontinuation before active conception attempts.”
This creates a planning problem. Dr Sowmya K N, consultant obstetrician and gynaecologist at Gleneagles BGS Hospitals in Bengaluru, names it directly. “The weight can return after stopping the medication if the patient does not actively change their lifestyle and monitor their metabolic rate,” she says. A woman who responds well to GLP-1 therapy must stop the drug before attempting conception. If the gap between stopping and conceiving stretches, the metabolic gains can erode.
“These medications must be discontinued before trying to conceive,” says Dr Sowmya. “The goal is to improve overall metabolic health and achieve sustainable weight loss, creating a healthy environment for pregnancy.” The drug, in this model, is a bridge. Sustained lifestyle change is the other bank, and not every patient reaches it.
Most reporting on GLP-1 drugs focuses on what patients lose. In fertility medicine, what patients fail to consume may matter just as much.
GLP-1 receptor agonists suppress appetite. That is central to how they produce weight loss. But a woman preparing for pregnancy who eats significantly less than before runs a nutritional risk that weight-loss trials do not capture.
Dr Shalini raises this concern directly. “Because of appetite suppression, there can be micronutrient deficiencies in some women, and that may affect fertility later on,” she says. “We are concerned about ensuring that women do not develop deficiencies while trying to lose weight.” Folic acid, essential for neural tube development in the first weeks after conception, is among the nutrients that inadequate food intake depletes.
“Fertility patients are different from other patients because nutrition is extremely important for reproductive health,” she says. “If appetite suppression becomes excessive and women are not eating healthy food, it can affect them in other ways. We always promote healthy weight loss. Weight loss should happen in a healthy fashion and not at the cost of nutritional status.”
In a country where anaemia affects a significant proportion of women of reproductive age, this concern carries particular weight. Fertility specialists must balance the benefits of metabolic optimisation with the nutritional demands of pregnancy preparation. “These are issues that also need to be considered,” says Dr Shalini. Whether GLP-1 therapy in pre-conception patients receives consistent nutritional monitoring across every clinic that prescribes it is a question the current evidence does not answer.
The conversation around GLP-1 therapies and fertility centres almost entirely on women. Obesity affects male fertility as well, and metabolic optimisation may become part of fertility planning for both partners.
Obesity suppresses testosterone production in men and reduces sperm quality through hormonal and inflammatory pathways. “In men, obesity leads to a decrease in testosterone hormone, so it can be used to correct that as well,” says Dr Yakasiri. Dr Sowmya adds that “men with obesity and metabolic concerns can also benefit from GLP-1 drugs as a weight management strategy, as obesity can also affect sperm quality and hormonal health.”
The evidence base for male reproductive benefits is even thinner than it is for women, but the logic runs parallel: improve metabolic health before conception, for both partners, not only the one who carries the pregnancy.
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The tension this story carries is not between doctors who care about evidence and those who do not. It is between those who read the current evidence as sufficient justification for selective use and those who read it as insufficient justification for any routine adoption.
“GLP-1 receptor agonists are likely to become an increasingly important part of pre-conception optimisation in the coming years,” says Murdia. “However, they are unlikely to become a routine treatment for all fertility patients and should be used selectively as part of an individualised and multidisciplinary approach to care.”
Singh agrees on the direction but keeps the destination carefully qualified. “We believe they may become an important option for selected patients, particularly those with obesity, PCOS, and insulin resistance,” she says. “However, they are unlikely to replace established fertility treatments. More clinical evidence and long-term data will be needed.”
Dr Shalini holds her ground. “There have been discussions at conferences and CME programmes,” she says, “but we are talking about it, not routinely practising it.”
Fertility medicine has traditionally focused on what happens after a couple decides to conceive. GLP-1 therapies are shifting attention to what happens before that moment arrives. Clinics are increasingly building a metabolic runway before pregnancy, constructing a pre-conception phase where weight, insulin, and hormonal function are brought into order before fertility treatment formally begins. Where that runway ultimately leads will depend on evidence that is still being gathered, in trials that are still running, for outcomes that remain, for now, unmeasured.
