Can I take leuprolide (Lupron) as a 43‑year‑old woman planning pregnancy?

Can You Take Lupron While Planning Pregnancy at Age 43?

No, you should not take leuprolide (Lupron) if you are actively planning to become pregnant. Leuprolide is contraindicated during pregnancy and must be discontinued before attempting conception.

Why Leuprolide Is Contraindicated

• Leuprolide causes fetal harm when administered to pregnant women, based on animal developmental and reproductive toxicology studies showing adverse embryo-fetal toxicity at doses less than the human dose. 1
• The FDA classifies leuprolide as potentially teratogenic, and pregnant patients and females of reproductive potential must be advised of the potential risk to the fetus. 1
• Leuprolide suppresses ovarian function by causing pituitary desensitization and down-regulation, leading to suppressed circulating levels of gonadotrophins and sex hormones—the opposite of what you need for conception. 2

The Only Exception: Fertility Preservation Context

The only scenario where leuprolide is used in women planning future pregnancy is as a GnRH agonist for fertility preservation in patients with systemic lupus erythematosus (SLE) who require treatment with alkylating agents like cyclophosphamide. 3

• In this specific context, GnRH analogues (including leuprolide) should be considered for all menstruating women with SLE who are going to receive alkylating agents to protect ovarian function from chemotherapy-induced damage. 3
• However, this is NOT for women actively trying to conceive—it is to preserve future fertility before gonadotoxic chemotherapy. 3
• The Task Force Panel did not reach consensus on the routine use of leuprolide for fertility preservation in SLE patients receiving cyclophosphamide, indicating this remains a nuanced decision. 3

What Happens If You Accidentally Conceive on Leuprolide

• Spontaneous pregnancies can occur during the initial "flare-up" phase of leuprolide administration (the first 1-2 weeks when gonadotropins transiently increase before suppression). 4
• Case reports document pregnancies exposed to leuprolide in early gestation that resulted in term deliveries without fetal anomalies. 4, 5
• One case series reported six pregnancies and four deliveries after inadvertent leuprolide exposure during the flare-up phase, with mechanisms allowing pregnancy to "escape" the luteolytic and abortifacient effects. 4
• A recent case described a woman who received two doses of 3.75 mg leuprolide and was found to have a viable 8+6 week pregnancy, which progressed to term cesarean delivery without fetal anomalies. 5

However, these are accidental exposures, not planned pregnancies, and the FDA warning about fetal harm remains in effect. 1

Critical Timing Considerations at Age 43

• Age 43 represents advanced maternal age with significantly reduced ovarian reserve and oocyte quality—no supplement or medication can reverse age-related decline in human fertility. 6
• Do not delay evidence-based fertility treatments in favor of any intervention that suppresses ovarian function, as this may further reduce your already limited conception chances. 6
• If you have an underlying condition (such as SLE) requiring leuprolide, pregnancy should be delayed until the disease is in stable remission for ≥6 months, as active disease at conception roughly doubles flare risk (RR ≈2.1) and markedly raises odds of pregnancy loss (OR ≈5.7) and preterm delivery (OR ≈6.5). 7

What You Should Do Instead

• Discontinue leuprolide immediately if you are currently taking it and wish to conceive. 1
• Consult with a reproductive endocrinologist to optimize your fertility potential given your age, using evidence-based ovarian stimulation protocols tailored to your ovarian reserve. 6
• If you have SLE or another rheumatic condition, coordinate care between rheumatology and reproductive medicine to ensure disease stability before conception. 3, 7
• Address modifiable lifestyle factors including tobacco cessation and alcohol reduction, which have established negative impacts on fertility. 6

Common Pitfall to Avoid

Do not confuse the use of leuprolide for fertility preservation (protecting ovaries during chemotherapy) with its use for achieving pregnancy. These are opposite clinical scenarios: one protects future fertility before gonadotoxic treatment, while the other requires active ovarian function for conception. 3, 6