Perspectives of Obstetricians and Gynaecologists on the Use of Weight Loss Medications

Abstract

Objectives: To investigate perspectives of Obstetricians and Gynaecologists on the use of glucagon-like peptide-1 receptor agonists (GLP-1RA) for weight loss in women living with obesity and subfertility. Methods: Qualified Obstetricians and Gynaecologists were invited via hospital networks, colleague groups, and clinical training bodies to complete an anonymous, online cross-sectional survey (May to September 2024). Results: Overall, 62 clinicians responded. Although 82.3% (n = 51) were familiar with GLP-1RAs, only 12.9% (n = 8) had prescribed them before. Most agreed that GLP-1RAs should be offered to patients with obesity-related comorbidities or sub-fertility, with 62.9% (n = 39) endorsing their use in women with subfertility and 71% (n = 44) supporting their use to meet body mass index (BMI) criteria for state-funded assisted reproduction technologies (ART). However, there was hesitation due to concerns about prescribing responsibilities and long-term follow-up. Most (79%; n = 49) felt that prescribing responsibility should lie with either a bariatric team or endocrinologist; no respondents felt that gynaecologists or fertility specialists should be primarily responsible for prescribing. Only 29% (n = 18) were aware that GLP-1RAs should be discontinued before conception, and 75.8% (n = 47) were not confident discussing potential teratogenic risks. Additionally, 96.7% (n = 60) expressed the need for more education and guidance on safety data. Conclusion: The study finds that targeted education, interdisciplinary collaboration, and clear guidelines are essential to bridge knowledge gaps and safely integrate GLP-1RAs into reproductive health care. This could offer significant benefits for managing obesity and improving fertility outcomes in women of reproductive age. 1 | Introduction Obesity is a global health concern with well-established contributions to cardiovascular and metabolic disease. An increasing body of research is interested in the associations between obesity and reproductive outcomes, affecting both male and female fertility. National figures derived from the Healthy Ireland Survey indicate that between 18% and 24% of men and women of peak reproductive age (25-44 years) have a BMI ≥ 30.0 kg/m 2 , while 50% of pregnant women presented as living either with overweight or obesity at their first antenatal clinic booking visit [1, 2]. In women, obesity is linked to altered menstrual cycles, polycystic ovarian syndrome (PCOS) [3], ovulatory dysfunction, decreased oocyte quality, subfertility and miscarriage [4-6]. Likewise in men, obesity is associated with impaired semen quality, altered sex hormone levels and higher rates of erectile dysfunction [7, 8]. Knowing these associations, gynaecologists and fertility experts frequently discuss weight loss with individuals trying to conceive. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.