Tirzepatide Management During Egg Retrieval in Patients with Diabetes
Discontinuation Timing Before Egg Retrieval
Tirzepatide should be discontinued at least 3 weeks (three half-lives) before egg retrieval to minimize the risk of pulmonary aspiration during anesthesia, even though this creates a temporary gap in diabetes management. 1
The critical safety concern is delayed gastric emptying, which persists even with extended fasting periods. Studies document retained gastric contents in 24.2% of patients on GLP-1 receptor agonists versus 5.1% of controls, despite 10-14 day discontinuation and 12-hour fasting 1. This creates significant aspiration risk during procedural sedation for egg retrieval 1.
Bridging Diabetes Management During Discontinuation
For Patients on Tirzepatide Alone (No Insulin)
- Monitor blood glucose 4 times daily (fasting, pre-lunch, pre-dinner, bedtime) starting when tirzepatide is stopped 2
- Restart metformin immediately if previously discontinued, or increase dose to maximum tolerated (up to 2000mg daily) 3
- Add short-acting insulin if fasting glucose consistently >180 mg/dL or random glucose >250 mg/dL during the 3-week discontinuation period 3
For Patients on Tirzepatide Plus Basal Insulin
- Increase basal insulin by 20-30% when stopping tirzepatide to compensate for loss of glucose control 2
- Monitor for hyperglycemia closely with blood glucose checks 4-6 times daily 2
- Add or increase prandial insulin if post-meal glucose exceeds 180 mg/dL consistently 2
Resumption After Egg Retrieval
Restart tirzepatide the day after egg retrieval once the patient has resumed normal oral intake and there are no complications requiring additional procedures 1. Resume at the same dose the patient was taking before discontinuation, as the 3-week gap does not require re-titration 1.
Special Considerations for Ovarian Stimulation
Glucose Monitoring During Stimulation
- Target fasting glucose 100-130 mg/dL and post-meal glucose <180 mg/dL throughout the ovarian stimulation cycle 3
- Ovarian stimulation hormones may worsen insulin resistance, requiring temporary insulin dose increases of 10-20% even before stopping tirzepatide 3
Antithrombotic Management (If Applicable)
If the patient has antiphospholipid antibodies or other thrombotic risk factors requiring anticoagulation:
- Stop low-dose aspirin 3 days before egg retrieval and resume the following day 3
- Stop low molecular weight heparin at least 12 hours prior to the procedure and resume the same day as long as there is no bleeding 3
Critical Contraindications to Verify
Confirm the patient does not have personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2, as these are absolute contraindications to tirzepatide 1, 2, 4.
Common Pitfalls to Avoid
- Do not continue tirzepatide through the egg retrieval procedure assuming standard fasting will be sufficient—the aspiration risk persists despite fasting 1
- Do not abruptly stop tirzepatide without a glucose monitoring and bridging plan—patients will experience significant glucose deterioration within days 2
- Do not restart tirzepatide at a lower dose after the 3-week gap—the patient can safely resume their previous maintenance dose 1
- Do not ignore the need for insulin intensification during ovarian stimulation—hormonal changes increase insulin resistance independent of tirzepatide discontinuation 3