Do you recommend the use of GLP 1 R agonist therapy for obese women with PCOS who are actively trying to conceive?

This is a very relevant question. GLP 1 RA therapy is recommended by the recently published International Consensus Guideline in Management of PCOS for assistance with weight loss in combination with lifestyle modification (Teede et al., PMID 37580314). The guideline states that this should be done in women using contraception since safety in pregnancy has not been determined.

In practice, however, patients with PCOS have found use of this class of medications quite effective for weight loss which will help improve menstrual function and lead to potential pregnancies. The BMJ article cited in this question is encouraging in that it looked at pregnancy outcomes in women with obesity and/or diabetes on this class of medication at the time of conception compared to similar women, not on a GLP 1 RA and found similar rates of several major outcomes.

There has even been a small positive study looking at liraglutide use to increase rates of pregnancy with IVF in PCOS patients (Salamun et al., PMID 29703793). I think it is still important, however, to let our patients know that this question has not been definitively answered but in the event of pregnancy, at least there doesn’t seem to be a significant concern for poor outcomes associated with use.

I will often use GLP1RA to help with weight loss in women with PCOS, with the added benefit of improving menstrual function and possible ease of conception down the road. However, I am clear that they should not be actively trying for pregnancy as we do not have sufficient safety data. When they have achieved weight loss and are ready to try to conceive, we stop the GLP1RA at that time. If actively trying to conceive, we use other modalities aside from GLP1RA.