While research is still emerging on the relationships between GLP-1 medications and birth control, fertility, and pregnancy, manufacturers of these popular weight-loss drugs have provided recommendations for women who are currently taking oral contraceptives to avoid pregnancy.

WHAT EXACTLY ARE GLP-1 MEDICATIONS?

Glucagon-like peptide-1 (GLP-1) receptor agonists are medications that have been used to treat type 2 diabetes for years. More recently, they gained approval for the treatment of obesity. GLP-1 medications work by mimicking the body’s natural GLP-1 hormones that regulate blood sugar, insulin release, digestion, and appetite. GLP-1 medications are commonly prescribed under the brand names of Ozempic, Wegovy, Mounjaro, Trulicity, and Zepbound. Within the past few years, GLP-1 prescriptions for non-diabetes patients have risen by more than 700%.

INTERACTION BETWEEN GLP-1 AND BIRTH CONTROL PILLS

Can GLP-1 medications make birth control less effective? There’s some evidence to suggest that popular weight-loss medications can affect how oral birth control works. For example, one study found evidence that a GLP-1 medicine called tirzepatide, that is sold under the brand name of Mounjaro had a greater impact on absorption of oral hormonal contraceptives than other GLP-1 medications. The study found that patients taking Mounjaro and oral contraceptives together resulted in a 20% decrease in overall exposure to oral contraceptives. Currently, there is no evidence suggesting that GLP-1 medications reduce effectives of non-oral contraception.

In response to findings on GLP-1 medications and birth control, manufacturers have put out usage recommendations for women taking oral contraceptives. Due to risks for decreased bioavailability of birth control pills, the manufacturer of Mounjaro (tirzepatide) recommends that patients either use barrier contraception for four weeks after initiation or dosage increase or switch to a non-oral contraceptive. Due to risks for diminished therapeutic effects of oral birth control pills, the manufacturer of Bydureon (exenatide) recommends taking birth control at least one hour prior to exenatide. The manufacturer of Adlyxin (lixisenatide) recommends taking oral birth control at least one hour prior or 11 hours after lixisenatide for the same reason. Currently, all other manufacturers of GLP-1 agonists assert that their products have no effect on the bioavailability of oral contraceptive pills.

Related: Ozempic Vagina: What Are The Side Effects Of Semaglutide?

ALTERNATIVES TO BIRTH CONTROL PILLS

Patients concerned about interactions between GLP-1 medications and birth control should talk to their care providers to make sense of manufacturer recommendations and learn about alternatives to oral contraceptives. Non-oral forms of contraception that bypass the digestive system are not believed to be affected by GLP-1 medications. This includes options like intrauterine devices (IUDs), injections, implants, rings, and patches. Patients should also be aware of the potential for increased fertility that stems from the weight loss and general health changes that many people experience after beginning GLP-1 medications. For women who have had difficulty conceiving due to obesity, it may be important to speak with your doctor about the potential for an unexpected pregnancy if birth control has not been a part of the equation due to perceived or assumed low risk for pregnancy.

GLP-1 WHILE PREGNANT

The simple answer is that women should not take GLP-1 while pregnant or attempting to conceive. Currently, there is a lack of long-term data on the safety of GLP-1 medications while pregnant. Recent studies show that exposure to GLP1-RA in the first trimester is not associated with a risk of major birth defects when compared with diabetes or obesity. While these findings offer reassurance in cases of inadvertent exposure to GLP-1 medications during the first trimester of pregnancy, larger trials are needed for more conclusive results. Additionally, animal studies have found that exposure to glucagon-like peptide-1 receptor agonists in pregnancy resulted in adverse outcomes for offspring that included decreased fetal growth, skeletal and visceral anomalies, and embryonic death.

The Food and Drug Administration (FDA) currently advises women to stop taking GLP-1 medications like Ozempic at least two months prior to trying to conceive. While the amount of time it takes the body to metabolize medication can vary by person, it takes an average of six weeks for most GLP-1 medications to be gone from the body in healthy, non-pregnant women. Patients who discover that they are pregnant while still taking a prescription GLP-1 medication should contact their care providers right away.

If you’re looking for more information on interactions between GLP-1 medications and birth control or how taking weight-loss medications may impact your fertility, Dr. Michael Tahery is a leading Obstetrician-Gynecologist (OB-GYN) and Urogynecologist serving the Los Angeles and Glendale areas. Book a consultation today.

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Symptoms of Female Infertility

The most obvious symptom of infertility is an inability to become pregnant. Diagnosis criteria can be met when attempting to become pregnant with frequent, unprotected sex for at least a year (six months after age 35) unsuccessfully. However, even someone who isn’t actively attempting to become pregnant at the moment may notice signs of infertility. An irregular menstrual cycle that is either too long or too short can also be a telltale sign. Finally, an absent or unpredictable menstrual cycle can indicate that ovulation isn’t taking place. Some women don’t experience any signs of infertility.

Causes of Infertility in Women

Infertility is a complex issue that can have many causes. It’s important to note that infertility is not just a female problem. It’s estimated that female infertility is the cause of 37% of couples experiencing infertility. Age can be a factor for many couples. Accelerated ovarian aging following age 35 is known to contribute to reduced fecundity that is associated with reduced ovarian reserve. As a woman ages, dwindling follicle reserve combined with the accumulation of DNA damage stemming from a lifetime of genotoxic exposure and oxidative burden can reduce fertility.

Fertility care is constantly evolving as the medical world learns more about the underlying mechanisms that contribute to the causes of female infertility. In recent years, the impact of cell-regulating proteins called sirtuins (SIRTs) has gained attention. SIRTs are involved in regulating cellular processes that include cell aging, cell death, and stress resistance. They’re also indicated in cellular homeostasis, energy metabolism, and apoptosis. Here’s a look at the leading causes of female infertility:

• Ovulatory disorders (25%): This can include polycystic ovary syndrome (PCOS), hypothalamic dysfunction affecting follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and primary ovarian insufficiency.

•  Endometriosis (15%): Endometriosis is a condition that occurs when tissue that typically grows in the uterus implants and grows in other areas. Dense tissue growth can cause scarring that prevents the egg and sperm from meeting. In cases where egg and sperm do meet, endometriosis can disrupt implantation.

• Tubal blockage (11%): Blocked or damaged fallopian tubes can block passage of ovulatory or fertilized eggs. Tubal impairment can stem from a wide range of causes that can include previous abdominal or pelvic surgeries, pelvic inflammatory disease, and STIs.

•  Hyperprolactinemia (7%): Marked by excessive prolactin in the blood, this condition is most commonly caused by a benign tumor in the pituitary gland. It can also be triggered by certain medications, underlying health conditions, or random and unexplained causes. Hyperprolactinemia is considered one of the most treatable causes of female infertility.

•  Pelvic adhesions (12%): Pelvic adhesions occur when scar tissue causes the surfaces of organs to fuse together. Infertility-associated adhesions are commonly found in the uterus and cervix. Causes include endometriosis, pelvic infections, STIs, and past abdominal or pelvic surgeries.

• Other tubal/uterine abnormalities (11%): Abnormalities can be caused by both genetic issues and injuries/surgical scarring. For example, a narrow or malformed uterus can make implantation more difficult.

RELATED: Fertility After 35

Female Infertility Treatment

For the millions of people struggling to conceive, female infertility treatments can provide a bright light on the journey to parenthood. The first step in any infertility treatment is diagnosing the underlying causes of female infertility that could be in play for a particular patient. From there, the pathway to treatment is highly individualized based on the health factors and personal goals in mind. It may be determined that surgery for correcting pelvic adhesions, scar tissue, fibroids, endometriosis, or polyps is necessary to increase the odds of pregnancy. Removing barriers to implantation can sometimes be enough to achieve natural pregnancy without further intervention.

In some cases, triggering ovulation using infertility drugs that mimic FSH and LH may be enough to facilitate a healthy pregnancy. Other patients may require intrauterine insemination (IUI) in order to achieve fertilization during ovulation. For patients who don’t find success with female infertility drugs or IUI alone, in vitro fertilization (IVF) that harvests mature eggs to create an embryo for transfer into the uterus is the next recommended step for some causes of female infertility.

Dr. Michael Tahery is a board-certified obstetrician-gynecologist (OB/GYN) and urogynecological surgeon in Los Angeles. Specializing in fibroid tumors, endometriosis, and pelvic pain, Dr. Tahery is committed to helping his patients find the right female infertility treatments to help them get the best outcomes possible. Treatments that address female infertility are also essential for improving overall health and quality of life. If you’ve been struggling to get pregnant don’t hesitate to book a consultation with Dr. Tahery. Contact our office today!

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Depending on the location and size of the fibroids, you might experience heavy bleeding, pelvic pain, discomfort during sex, and other unwanted symptoms. But do fibroids affect pregnancy and fertility?

Fibroids and Fertility

Unfortunately, fibroids can impact your ability to get pregnant. However, the good news is that most women with fibroids can conceive naturally. With guidance and care from a fibroids specialist, the odds of having a successful pregnancy are even higher. Fertility issues are relatively rare. Whether or not they cause infertility depends on many factors.

One crucial detail that makes fibroids affect pregnancy and fertility is location. These tumors can develop in various parts of the uterus. Submucosal fibroids generally have the most impact on fertility. These growths appear just under the endometrium and protrude into the uterine cavity. This type of fibroid makes up just five percent of all fibroid cases. They’re the rarest but also one of the most problematic.

Larger fibroids over six centimeters in diameter are also to blame for fertility issues. Regardless of the tumor’s location, the sheer size of the growth can cause significant fertility problems.

These types of fibroids can affect fertility in a few different ways.

First, the growths can change the shape of the uterus entirely. As a result, fewer sperm can enter the uterus. Furthermore, the malformed nature of the uterus can disrupt the sperm’s movement as it makes its way to the egg during conception.

Fibroids can also block the fallopian tubes or change the size of the uterine lining. Even if the sperm successfully penetrates the egg, there’s no guarantee that the embryo will implant in the uterine wall. Fibroids can restrict blood flow, stopping development before it even begins.

It’s true that fibroids affect pregnancy, but these cases are rare. Most women with these tumors can conceive without any issues. If you’re in doubt, don’t hesitate to reach out. Dr. Tahery specializes in fibroid evaluation and treatment.

RELATED: Minimally Invasive and Non-Surgical Fibroid Treatment Options

Fibroids During Pregnancy

One of the most common questions people have about these non-cancerous growths is whether or not fibroids affect pregnancy and delivery. Once again, it’s possible but rare.

Between two and 12 percent of pregnant women receive a fibroid diagnosis. But an estimated 10 to 30 percent of that figure develop complications during pregnancy. That means most women with fibroids have perfectly normal pregnancies without any challenges.

In those instances when fibroids affect pregnancy, it’s usually in the first trimester. Experts believe that these growths rely on estrogen to grow. Because your body produces more estrogen during the first third of the gestation period, that’s when complications manifest.

The biggest concern due to fibroids in pregnant women is preterm births and the possibility of miscarriage. Unfortunately, women with fibroids have an estimated 14 percent chance of miscarriage. That’s noticeably higher than the 7.6 percent risk in women without fibroids. The dangers increase with larger tumors.

Fibroids can also put you at a higher risk of preterm birth before 37 weeks and cesarean delivery.

Other potential concerns include extreme pain and developmental problems. As the uterus expands in the second and third trimesters, it can push against the tumors. The fibroids may twist or even outgrow their blood supply, creating severe stomach pain that could result in miscarriage.

In cases of extreme fibroid growth, placental abruption can occur. When this happens, the placenta tears away from the uterine wall, cutting off oxygen to the fetus and causing heavy bleeding.

Diagnosis and Treatment of Fibroids

The best way to minimize the ways fibroids affect pregnancy is to be proactive about treatment. Diagnosing these uterine tumors is a straightforward process. We use 3D ultrasound technology to evaluate the size, location, and the number of growths.

After diagnosis, we can recommend a course of action that’s right for your needs. Possible treatment options include hormone therapy, radiofrequency ablation, and embolization. Hormone therapy uses gonadotropin-releasing hormone agonists to decrease estrogen and progesterone levels that feed the fibroids. Meanwhile, ablation and embolization aim to reduce the size of the tumors and cut off their blood supply.

Whether you have plans to get pregnant or not, contact Dr. Michael Tahery to explore treatment options for your fibroids. Dr. Michael Tahery is a urogynecologists who understands the complex nature of fibroids and their potential impact on pregnancy and fertility. Contact our offices today to learn more and schedule your appointment.

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Not to be confused with premenopause, perimenopause affects all women differently. Some will notice changes in their 30s. However, others may go through this stage for only a few months before reaching menopause.

Either way, the body’s production of estrogen rises and falls unevenly. As a result, women experience a wide range of perimenopause symptoms. Fortunately, treatment options are available to ease the transition. Here are some of the most common symptoms women can experience:

Irregular Periods

Erratic periods are standard during perimenopause. Ovulation becomes more unpredictable, leading to changes in the flow and length of periods. The space between periods can vary as well.

The changes can be so significant that some women assume they have entered menopause. Despite the drop in fertility, it’s still possible to get pregnant during perimenopause. It’s only when a period doesn’t occur for 12 months that doctors typically diagnose full menopause.

A specialist may recommend treatment options if symptoms begin to interfere with daily life. These may include hormone therapy, lifestyle changes, and more.

RELATED: 4 Common Reasons You Might Be Experiencing Irregular Periods

Hot Flashes

Hot flashes are an infamous sign of menopause. However, these bouts of sudden body heat can occur during perimenopause, too. They’re one of the most common symptoms, affecting more than two-thirds of women heading into menopause.

Characterized by an intense wave of heat over the face, neck, and chest, hot flashes can result in profuse sweating and sleeping issues. The frequency and severity of hot flashes vary based on the hormonal changes within.

Luckily, a specialist can help manage hot flashes with hormone treatments like birth control, patches, gels, and more.

Mood Swings

Not all perimenopause symptoms are physical. In many cases, the transitional period causes noticeable emotional instability. Sometimes called “Perimenopause Rage,” these mood swings differ from standard anger or frustration.

Some women describe it as a sudden shift to intense irritation, resentment, or a lack of patience.

Mood swings occur for a variety of reasons. They could be a product of sleep disruption from hot flashes or outside factors. Internally, there’s a chemical reason for the emotional shift.

Estrogen impacts the release of serotonin, the body’s mood regulator hormone. With erratic estrogen production, serotonin levels become unstable. With time lost symptoms improve as the body adjusts to a low hormonal environment.

RELATED: Menopause and Brain Fog

Weight Gain

Weight fluctuations are prevalent in perimenopausal women. Studies suggest that lower estrogen levels change how the body stores fat. Throughout the reproductive stage, women store fat in the hips and thighs. It’s subcutaneous fat, which is usually harmless and doesn’t increase one’s risk of disease.

However, during perimenopause, the dip in estrogen causes the body to store fat in the belly area. It takes the form of visceral fat. Unfortunately, visceral fat comes with higher risks of heart disease, insulin resistance, and a range of health problems.

Of all the perimenopause symptoms, this is one that many women overlook. A crucial part of treatment is to adopt a healthier lifestyle to combat weight gain.

RELATED: Weight management in Los Angeles

Vaginal Dryness

The vaginal tissue can suffer significantly during perimenopause. Estrogen is a vital hormone that governs vaginal elasticity and natural lubrication. When this hormone’s presence in the body decreases, dryness occurs, and vaginal tissue thins. 

The dehydration is not just limited to the vaginal tissue. Many women experience it on the face and other parts of the body as well. However, vaginal dryness can affect sexual health and comfort. Furthermore, a lack of moisture and resilience may make women more vulnerable to vaginal and bladder infections. 

Vaginal dryness is one of those perimenopause symptoms that many women don’t bring up to their specialist. But, there are plenty of treatment options to stave off the effects of hormonal changes.

If you notice any of these perimenopause symptoms, go to a specialist like Dr. Tahery for professional care. Dr. Michael Tahery is a urogynecologist who specializes in both women’s health and urology. He’s spent the last two decades helping women in the Los Angeles area manage this life change. Call us today to schedule an appointment.

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Estrogen, primarily produced by the ovaries, is the primary hormone responsible for growth of the follicle. 

Progesterone produced by the ovulatory follicle, also known as the egg, is responsible for maintaining the endometrial lining and allowing the pregnancy to progress. 

Testosterone is also known as a male hormone which is also essential in a women’s body. Too much testosterone however will disrupt the ovulatory cycle and result in fertility issues. This condition is seen in women with polycystic ovaries or pcos.

Prolactin is produced by pituitary gland located in the base of the brain and is responsible milk production after delivery among other functions. Too high a level of prolactin from an overgrowth of pituitary gland may also disrupt the ovulation cycle. One such tumor is called a prolactinoma.

Thyroid hormones are essential to normal functioning of our body including the reproductive organs. Too much or too little thyroid hormone production from the thyroid gland can disrupt ovulation among many other problems. 

LH or leutenizing hormone also produced in the pituitary gland located in the base of the brain is responsible for inducing release of the egg from a mature follicle. Absence of a strop LH surge prevents ovulation. 

What factors cause hormone imbalance?

Genetics, hereditary, autoimmune disorders, obesity, severe weight loss, prolonged high intensity exercise and tumors of the hormone producing organs are the major factors in hormonal imbalance. 

Symptoms of hormone imbalance?

• Elevated testosterone results in irregular menstruation, acne, and thick body and facial hair. 
• Elevated prolactin causes headaches, visual changes, and milk production from the breasts. 
• Low progesterone levels may result in recurrent miscarriage. 
• Low estrogen prevents thickening of the endometrial lining and poor follicle growth. 
• Too much thyroid hormone results in disruption in ovulation and too little heavy menstruations. 
• Poor LH surge results in infrequent ovulations.

Infrequent or absent ovulation, and irregular menstruations are some of the fertility issues that are most commonly linked to hormone imbalance.

Are at-home tests helpful?

An ovulation test is a form of hormone testing which checks for the LH surge and the results are helpful to your doctor.

Consult a Board-Certified medical provider for more information if you suspect that a hormonal imbalance might be affecting your fertility. Schedule a consultation with Dr. Michael Tahery at his Glendale or Los Angeles office if you have any questions.

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The use of NSAIDS in pregnancy have been restricted. It is well established that NSAID use in the third trimester of pregnancy significantly prohibits fetal urine production and amniotic fluid volume. It also increases the risk of premature constriction of the ductus arteriosus leading to fetal heart failure and even death.

Recent research from Kaiser Permanente has found more bad news. Use of Nonsteroidal anti-inflammatory drugs in the first trimester also increases the rate of miscarriage. NSAIDS prohibit prostaglandin production essential to successful implantation of the embryo. Abnormal implantation increases the risk of miscarriage. Nonsteroidal anti-inflammatory drugs effect on the risk of miscarriage has been shown to be dose-related. The higher the frequency and the dosage the higher the risk of miscarriage. Women at lower body mass index may be most vulnerable to this effect.

My policy in pregnancy and otherwise has been the least use of medication possible. History and experience have shown that many of the medications we use and take their safety for granted will be found to be harmful in ways we never imagine today. Natural remedies and holistic approaches are always best when possible.

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Time goes by fast. While we are going to school, building a career, and getting ready to get pregnant, time slips away. The number of women trying to get pregnancy after the age of 35 is growing.

At 35 the chance of getting pregnant is 29% in each cycle, almost half of that before 35, and at 40 the chance of pregnancy is 5%. As we get older the number and the quality of the eggs suffer. The release of the eggs still happen every month but they are less likely to get fertilized.

Also, the chance of spontaneous miscarriage increases with time. Under 35 years old: 15 percent chance of pregnancy loss. Between 35–45 years old: Between 20 and 35 percent chance of pregnancy loss.

A group of blood tests and ultrasound evaluations allow us to evaluate the egg count and quality in couples that are having difficulty getting pregnant over the age of 35. There are many options available for women trying to get pregnant or those who want to preserve their fertility.

Timed ovulation is the first step towards getting pregnant. It is monitoring ovulation in a woman’s cycle by urine, blood, or ultrasound and commence intercourse 2 days prior to ovulation.

Ovulation induction is the next step, using hormonal agents to stimulate egg production. This step can be combined with IUI (intrauterine insemination) where a prepared sperm collection is injected inside the uterus bypassing the vagina and the cervix.

RELATED: Infertility Treatment in Los Angeles

The last and final option is in-vitro fertilization (IVF). In this procedure the fertilized egg is implanted in the mother’s womb.

For women without a partner and no plans for pregnancy in the near future, egg freezing provides an option to save eggs for when the time is right for pregnancy. For those with a partner but no pregnancy plans, fertilized eggs can be preserved for future implantation.

Time is of essence. The earlier the better. Start trying as soon as you feel you are ready. This is my advice to those who ask. Even if you feel the time is passed there are still options to explore.

Let us know if we can help. We are committed to helping you reach your dreams.

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How many couples do you know trying to get pregnant and have difficulty? Or have “fertility anxiety”?

On any given day in my practice, I am faced with the seemingly straight forward, yet complex question from women at various stages of their lives; “can I get pregnant?”. Women in their twenties and nervous about their health; those in their thirties worried about the metaphorical clock ticking away; and women in their forties optimistically seeking guidance. Some may have tried a few cycles naturally to get pregnant and others may not be ready yet.

Fertility is big news because the rate of infertility is increasing in both men and women. Several factors are implicated and the most common are environment, age, genetics, and medical conditions.

Diet and environmental toxins are very concerning topic. Pesticides, hormones added to foods, chemicals in the air we breathe and water we drink may play an important role. It effects the health of the female ovaries and the eggs they produce; it also effects the number and quality of sperm in men.

Advanced maternal age is another big factor. As ovaries age, the produced eggs are harder to fertilize. The number of eggs also decrease with age. The rate of attrition increases after 30, speeds up after 35 and at 40 very few eggs are left. If you are from a family with children born to mothers in their forties, your chance of having children later in life also increases. Genetics is an important factor and is much harder to analyze. Testing can determine your approximate egg count and quality and many of the factors that impede fertility.

Medical conditions that may not play a significant role in the fertility of a young adult can become serious factors as the person ages. Fibroids and endometriosis are two common examples. These conditions worsen with age and cause damage to reproductive organs. Hormonal imbalance such as polycystic ovarian syndrome, disrupt ovulation cycles and make eggs weaker. Simple office evaluation can diagnose many of these medical conditions.

Some of the fertility anxiety experienced by women may be justified and many are not, and most are easily treated. Discuss any concerns with a gynecologist. There are many ways your fertility can be evaluated. Simple, tried and true instructions can increase your odds of pregnancy, such as treating your body better with a balanced diet, exercise, and getting your checkup at least annually. In my practice, at times, simple solutions and early detection have made tremendous improvements in a couples fertility.

Oddly enough, anxiety about fertility has shown to reduce the chances of pregnancy. So, relax. Seek the help of a gynecologist.

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Another common urinary condition after pregnancy, especially vaginal delivery, is Stress Incontinence. This is the leakage of urine with any strenuous activity. This could include jumping, coughing, laughing, or even sneezing. During a vaginal delivery, the supports for the bladder become stretched or torn. The damage is responsible for stress incontinence. Several patients have complained that after their pregnancy and delivery, they could feel the urine fall when they walked or jumped.

If you notice that you have developed urinary control problems after having a baby, report it to your gynecologist. You can also schedule a consultation with a urogynecologist, a physician that specializes in repairing damages resulting from a pregnancy. Dr. Tahery is a urogynecologist in practice for the past 22 years and heads the Center of Excellence at Cedars Sinai in Women’s Pelvic Health.

Evaluation and testing is done in our office in an efficient and effective manner. Treatment options can include exercise, therapy, medication, minimally invasive surgery or out-patient surgical procedures.

As always, the most important message is that the earlier you address the problem, the easier it is to treat.

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