Is Zepbound safe to use in In Vitro Fertilization (IVF) treatment protocols?

Zepbound and IVF Treatment

Zepbound (tirzepatide) should be discontinued before starting IVF treatment protocols, as weight loss medications in this class are not recommended during fertility treatments or pregnancy.

Key Contraindication

While the provided evidence does not contain specific FDA labeling for Zepbound, GLP-1 receptor agonists and related weight loss medications are generally contraindicated during fertility treatments and pregnancy based on standard reproductive medicine principles. The medication should be stopped well in advance of ovarian stimulation.

IVF Treatment Protocols - Standard Approach

Ovarian Stimulation Process

• IVF requires 10-14 days of ovarian stimulation starting from the beginning of the menstrual cycle 1
• Follicle-stimulating hormone (FSH) is typically initiated at 150 IU daily on Day 2 or 3 of a natural menstrual cycle 2
• GnRH antagonists (like ganirelix) are administered starting on Day 6-8 of FSH treatment to prevent premature LH surges 2
• Both FSH and GnRH antagonist are continued until at least three follicles reach ≥17 mm diameter 2
• hCG trigger is then administered, followed by oocyte retrieval 34-36 hours later 2

Treatment Selection Considerations

For unexplained or mild male factor infertility:

• IUI with ovarian stimulation should be offered first for women ≤38 years old, as it is equally effective as IVF when considering 3 cycles of IUI-OS versus 1 cycle of IVF 1, 3
• IUI-OS is less invasive, more comfortable, markedly less expensive, and has higher patient compliance 1, 3
• Move to IVF after 3 unsuccessful IUI-OS cycles - this is the most cost-effective approach 1

IVF as first-line treatment is appropriate when:

• Female partner is >38 years old (due to age-related fertility decline) 1
• Severe male factor infertility (total motile sperm count <5 million) 1
• Tubal factor infertility requiring IVF 1
• Time to pregnancy is critical and patient prefers more aggressive treatment 4

Special Populations Requiring Modifications

Patients with Antiphospholipid Antibodies or APS

• Prophylactic anticoagulation with heparin or LMWH is conditionally recommended during ovarian stimulation in asymptomatic aPL-positive patients 1
• Strongly recommend prophylactic anticoagulation in women with obstetric APS 1
• Strongly recommend therapeutic anticoagulation in women with thrombotic APS during ART procedures 1
• Enoxaparin 40 mg daily is typically started at beginning of stimulation, held 24-36 hours before retrieval, then resumed 1
• Consider aromatase inhibitor protocols to yield lower peak estrogen levels and reduce thrombosis risk 1

Patients with Hypertrophic Cardiomyopathy

• IVF should be avoided in patients with heart failure, atrial fibrillation, or severe hypertrophy with restrictive LV filling pattern 1
• IVF is probably safe in low-risk HCM patients but carries risks due to fluid retention and thromboembolism 1

Critical Safety Considerations

Multiple Pregnancy Prevention

• IUI should be withheld when >2 dominant follicles ≥15 mm or >5 follicles ≥10 mm are present at time of hCG trigger 1
• This strict cancellation criterion is essential to maintain singleton delivery rates 1
• IVF with single embryo transfer provides better control over multiple pregnancy risk 1

Ovarian Hyperstimulation Syndrome Risk

• Patients with thrombophilia (including aPL) have increased risk of severe OHSS 1
• OHSS can cause capillary leak syndrome, pleural effusion, ascites, and arterial/venous thrombosis 1
• Aromatase inhibitor protocols may reduce OHSS risk 1

Common Pitfalls to Avoid

• Do not continue testosterone therapy in men seeking fertility - it suppresses spermatogenesis and should never be prescribed for infertile males interested in current or future fertility 1
• Do not skip anticoagulation in aPL-positive patients - even asymptomatic patients require prophylaxis during the high-estrogen state of ovarian stimulation 1
• Do not proceed with IVF without proper timing - the 2-6 week delay required for proper cycle timing must be factored into treatment planning 1
• Do not use weight loss medications during fertility treatment - these should be discontinued before starting ovarian stimulation protocols