Dr. Ali Ainsworth: Yeah, so, as you said, very common. We are not prescribing them in our clinic, but we are very often referring to primary care to endocrine to others to prescribe the data about GLP-1s in pregnancy. To be honest, it is just limited because it’s a new medication. Current recommendations are not to try for pregnancy while on GLP-1s, stop for two months before attempting pregnancy.
Tara Schmidt: Bariatric surgery.
Dr. Ali Ainsworth: Another really good option, both short and long term. A much harder ask of people [because it requires] avoidance of pregnancy for one year after that surgery to make sure the weight stabilizes.
Tara Schmidt: Yeah, that first year in bariatric surgery, you are losing weight so, so rapidly. Depending on the type of surgery that you’ve had, you may have truly a malabsorptive procedure purposefully, which is the mechanism of action. We need to stabilize, like you said, weight and nutrient stores, make sure that they’re eating well, make sure that they’re maintaining a healthy weight to become pregnant. It’s a long that’s a long ask.
What options are available to patients beyond focusing on their weight?
Dr. Ali Ainsworth: Sperm counts. Are the fallopian tubes open, are they ovulating regularly, which often you can tell by history alone, and if they’re not, what additional testing might we do to better understand the underlying cause? Then depending on what we find, our options are always continued timed intercourse. There’s nothing that says you can’t do that, we just have to acknowledge the lower likelihood of success, or are we talking about oral medications, intrauterine insemination, IVF, donor egg, donor sperm? There’s so many permutations of where we go, but it always just begins with a visit and initial testing to understand where in the process we might intervene.