* Content note: Please note that this article addresses sensitive topics related to body mass index (BMI), weight stigma, infertility, and mental health. BMI is referenced critically within the context of reproductive healthcare and its impact on access to fertility treatments.
In recent months, stories of so-called “Ozempic babies” have captured public attention, as individuals previously considered infertile report unexpected pregnancies after using popular weight-loss drugs like Ozempic and Wegovy. While the phenomenon has stirred excitement for some, it also highlights deeper ethical issues in fertility care—especially the reliance on BMI-based restrictions. For many, BMI cutoffs represent more than a medical guideline; they echo longstanding barriers in reproductive healthcare that disproportionately impact marginalized groups, including Black, Indigenous, LGBTQIA+, and disabled individuals. By framing BMI thresholds as necessary safeguards, fertility clinics risk perpetuating a pattern of exclusion that obscures the complex social factors truly influencing health, raising profound ethical questions about autonomy, justice, and equity in reproductive care.
These accounts of “Ozempic babies” often come from individuals who were previously considered infertile or relied on hormonal contraceptives, only to find themselves unexpectedly pregnant after using medications, like Ozempic and Wegovy. These drugs, designed to manage blood sugar and promote weight loss, mimic the hormone Glucagon-Like Peptide-1 (GLP-1) by increasing insulin release, slowing digestion, and reducing appetite. While some suggest that improved metabolic health could be behind the restored fertility, others caution that these drugs were not designed to treat infertility and that their long-term effects remain unclear.
The anecdotal reports of “Ozempic babies” suggest that weight loss among individuals classified as “obese” can improve fertility. Studies have shown that weight loss can positively affect hormonal, metabolic, and physical aspects of the reproductive system. This is because obesity is believed to disrupt hormone balance, leading to irregular menstrual cycles and reduced ovulation, and therefore, weight loss could help restore these hormones, making ovulation more regular. It could also improve egg quality by reducing inflammation and metabolic stress, creating a healthier environment for fertilization and embryo development. Additionally, weight loss could enhance the uterine lining (endometrium), making it more capable of supporting embryo implantation. By reducing overall inflammation and normalizing hormone levels, weight loss could make conception more likely and increase the success rates of fertility treatments like in vitro fertilization (IVF).
Weight loss has also been found to reduce pregnancy-related risks among individuals with higher BMIs, such as gestational diabetes, preeclampsia, hypertension, and blood clots, as well as surgical risks like anesthesia complications and airway management challenges during cesarean sections. There are also concerns about fetal risks, including congenital anomalies, macrosomia (excessive birth weight), and stillbirth. Beyond immediate risks, higher maternal BMI can have long-term health impacts on children through epigenetic mechanisms that elevate their susceptibility to metabolic conditions.
Given the potential benefits of weight loss for improving fertility and reducing pregnancy-related risks, some argue that weight management should be encouraged or required as part of preconception care before pursuing fertility treatments. Many fertility clinics impose BMI thresholds (e.g., 35 or 40) as criteria for accessing treatments like IVF, citing both medical risks and technical challenges associated with higher BMIs. A higher BMI can also complicate fertility treatments: increased tissue depth makes ultrasound-guided egg retrieval more difficult, and individuals with higher BMIs may require higher doses of hormonal medications with less predictable responses. Given how expensive, resource-intensive, and precarious these assistive reproductive interventions are, some argue that BMI cutoffs are justified to avoid subjecting people to invasive procedures when chances of conception may be diminished due to their weight.
While the phenomenon of “Ozempic babies” introduces excitement for some who have struggled to conceive, it also raises questions about whether weight-loss interventions could be a more integral part of preconception care or whether they inadvertently reinforce weight bias. At a broader level, these discussions risk perpetuating restrictive standards for reproductive health and pressuring individuals into narrowly defined preconditions for care. As we consider the possibilities and concerns of the “Ozempic baby” era, it is crucial to recognize how BMI standards in fertility treatment raise ethical concerns regarding autonomy, beneficence, non-maleficence, and justice.
Autonomy: In healthcare, autonomy is about honoring patients’ rights to make informed decisions about their bodies and care without undue limitations or coercion. Unfortunately, BMI cutoffs in fertility clinics restrict reproductive choices by denying treatment based on a single, outdated metric. Studies show that BMI often fails to predict individual health outcomes accurately, especially in reproductive contexts. Using BMI to restrict fertility options overlooks individual health variations and can unjustly exclude people who may otherwise be healthy and ready for pregnancy. As a result, when clinics mandate weight loss without evidence of its direct benefits for fertility, they infringe on personal autonomy, pressuring patients to meet arbitrary standards rather than supporting them in making informed, individualized choices. This effect is particularly harmful to people with conditions like polycystic ovary syndrome (PCOS), who may not experience improved fertility simply from weight loss. Improvements in fertility for those with PCOS depend on metabolic factors like insulin sensitivity and inflammation rather than just body weight. Rapid or excessive weight loss, in fact, can disrupt hormone levels or increase oxidative stress, ultimately harming fertility rather than helping it. This pressure can create a cycle of psychological stress, which itself can disrupt hormones and worsen reproductive health. For marginalized individuals who already face barriers to care, such restrictions amplify feelings of exclusion and disempowerment, undermining their autonomy in navigating reproductive choices.
Beneficence & Non-Maleficence: The principles of beneficence and non-maleficence in healthcare mean that treatments should aim to benefit patients and avoid causing harm. However, weight-centric policies in fertility care often fail to meet this standard, and can instead lead to both physical and psychological harm. Studies demonstrate that weight stigma and the pressure to lose weight can increase stress, leading to disordered eating and weight cycling—patterns of weight loss and regain that worsen metabolic health. Weight stigma results in elevated cortisol levels and healthcare avoidance, leading to adverse physical and psychological outcomes. For people with PCOS and other conditions that affect fertility, the stress and metabolic disruptions from these weight-loss pressures can actually make it more difficult to conceive. For many, metabolic factors such as insulin sensitivity, oxidative stress, and inflammation—not weight alone—are primary considerations for fertility. Consequently, a rigid focus on weight loss can worsen these issues, harming the very health the clinic intends to support.
Moreover, weight loss does not consistently lead to better outcomes in fertility treatments like IVF, where success often depends on factors like age, ovarian health, and endometrial condition. Focusing on BMI and weight loss can detract from more effective fertility strategies, such as ovulation induction or addressing underlying conditions directly. For patients with time-sensitive fertility concerns, delaying treatment to achieve weight-loss targets may lead to missed opportunities for conception, directly contradicting the principle of beneficence by putting arbitrary weight goals ahead of actual fertility needs.
Justice: Justice in healthcare emphasizes fair and equitable access to care. Unfortunately, BMI-based recommendations and policies in fertility treatment fall short of this standard. They not only arbitrarily exclude or harm individuals of a certain BMI, but they also disproportionately impact marginalized communities—particularly Black, Hispanic, low-income, and LGBTQIA+ individuals—who already face greater health inequities due to social, economic, and structural barriers. For disabled people, these policies can be compounded by inaccessible healthcare facilities, inadequate provider training, and assumptions that devalue their reproductive autonomy. Structural issues like food deserts, income inequality, and limited access to safe exercise spaces contribute to higher average BMIs in many marginalized groups, making them more likely to be excluded from fertility care. Additionally, factors such as economic stressors, stigma (including weight stigma) and discrimination, adverse childhood experiences, and neighborhood environment elevate stress biomarkers, such as cortisol, which in turn can increase BMI. Elevated cortisol disrupts metabolism by promoting abdominal fat storage and insulin resistance—factors closely linked with PCOS. By enforcing BMI-based recommendations, fertility care unjustly penalizes individuals for health outcomes shaped by systemic inequities, deepening existing disparities rather than addressing them.
Despite these ethical concerns associated with BMI standards, some may still say that these policies reduce pregnancy complications like gestational diabetes and preeclampsia. However, critics highlight that individualized care can achieve similar outcomes without excluding patients based on weight. Personalized approaches—such as regular glucose monitoring, tailored nutritional counseling, and targeted medical support—allow clinics to manage potential complications effectively while providing equitable access to care. Holistic protocols that prioritize metabolic health and mental well-being, including preconception screenings for insulin resistance, anti-inflammatory diets, structured exercise, and mental health support, can enhance fertility and overall health outcomes without mandating weight loss. These approaches focus more on reducing oxidative stress, improving insulin sensitivity, and enhancing overall metabolic health rather than enforcing weight loss. By moving beyond rigid BMI standards, clinics can focus on strategies that address each patient’s unique health needs and uphold ethical standards of care. These policies infringe on patient autonomy by prioritizing weight over individualized health, often causing more harm than good. They also disproportionately impact marginalized communities—including Black, Hispanic, low-income, and LGBTQIA+ individuals—who already face significant healthcare inequities. Reproductive health should not be constrained by rigid weight standards; instead, it must center on safe, inclusive, and personalized care for all. As public conversations around ‘Ozempic babies’ and GLP-1 drugs unfold, it is crucial to avoid reinforcing weight stigma and pressuring individuals into pharmaceutical solutions that may not align with their broader health or personal values. In a truly just healthcare system, every person—regardless of body size, gender identity, or background—would have equal opportunity to pursue their reproductive goals with dignity and support.
Kayla R. Mehl
Kayla R. Mehl (she/her/hers) is a Hecht-Levi Postdoctoral Fellow at Johns Hopkins Berman Institute of Bioethics. She specializes in bioethics (esp. health justice, philosophy of disability, and research ethics) and feminist philosophy.
Link to Berman Institute profile: https://bioethics.jhu.edu/people/profile/kayla-mehl-phd/
Link to personal website: https://www.kaylarmehl.com/
