Project 4 Outline: GLP-1 receptor agonists in pre-conception care: behavioural, reproductive and economic implications for fertility treatment in women with obesity

Supervisors

Dr Joanne Cecil (School of Medicine) Dr Javier Tello (School of Medicine), Dr Tugce Cuhadaroglu (Business School)

Project description

Obesity disproportionately affects women of reproductive age and is associated with menstrual disturbances, subfertility and adverse pregnancy outcomes. BMI thresholds (typically < 30kg/m²) restrict access to fertility services, often making weight loss a prerequisite for treatment. GLP-1 receptor agonists (GLP-1 RAs) are increasingly used to support preconception weight-loss and may improve reproductive function, but preclinical data raise concerns about potential teratogenicity and human data on periconceptional use is limited. Current guidance therefore recommends discontinuing GLP-1RAs before conception although adherence to this guidance is variable. Consequently, the behavioural, clinical and economic consequences of GLP-1 RA use in women seeking fertility treatment remain poorly characterised.

This project investigates the behavioural, reproductive, and economic implications of GLP-1 RA use in women with obesity seeking fertility treatment.  It explicitly frames preconception decision-making as an intertemporal choice problem under uncertainty, where individuals trade off short-term access to fertility treatment against uncertain longer-term risks related to medication use and pregnancy outcomes, within the constraints imposed by clinical guidelines and access policies. The project has 3 research objectives:

• Synthesise the evidence on GLP-1RA effects on metabolic and ovarian biomarkers and periconceptional use and pregnancy risks (RO1).
• Identify behavioural determinants of GLP-1 RA uptake and adherence during the periconceptional period among women with obesity, with a focus on behavioural frictions such as present bias, risk perceptions, informational constraints, and social norms (RO2).
• Develop a decision-analytic economic model evaluating the cost-effectiveness of GLP-1 RA-assisted weight optimisation prior to fertility treatment compared with BMI-threshold policies, and their impact on access, time-to-treatment, and reproductive outcomes (RO3).

The student will conduct a structured evidence synthesis to quantify associations between GLP-1 RA use and reproductive biomarkers and examine data on their use during periconception and risks for obstetric and pregnancy outcomes (RO1). Semi-structured interviews with women of reproductive age who are living with obesity will be conducted to explore decision-making processes, behaviours and perceptions (RO2). These components will feed into the development of a decision-analytic model of pathways into fertility treatment. The model will incorporate heterogeneity in patient characteristics (e.g. BMI, age, reproductive health), endogenous adherence to clinical guidance, and timing decisions regarding GLP-1RA use and treatment entry. It will evaluate alternative policy regimes, including BMI-based access restrictions, discontinuation guidelines, and access to GLP-1RAs, assessing their implications for efficiency, equity, and patient welfare, as well as clinical outcomes (RO3).

By integrating behavioural evidence, clinical data, and economic modelling, the project will provide a comprehensive framework for understanding how emerging weight-loss treatments interact with fertility policies and patient decision-making. The findings will inform clinical guidance and health policy by identifying trade-offs between safety, access, and outcomes, and by demonstrating how behavioural responses shape the effectiveness of preconception interventions.

The student will develop skills in systematic evidence synthesis, qualitative methods, behavioural theory, and health economic modelling. Interdisciplinary supervision will provide exposure to clinical research, behavioural science, and health policy evaluation.

Subject areas and keywords

Obesity, GLP-1 receptor agonists, neurobiology, energy homeostasis, fertility treatment, pregnancy, human behaviour, behavioural economics, health economics, health policy, access to care, economic modelling.

Skills & Requirements

We seek a highly motivated candidate with a good bachelor’s degree in psychology, biology, economics or a related discipline, with an interest in interdisciplinary research at the intersection of behaviour, health, and policy. An interest in decision-making, behavioural economics, and health economic modelling is particularly desirable. Prior experience with quantitative and qualitative methods is welcomed, but comprehensive training will be provided by the supervisors.

Further details and application process

This project has been awarded St Andrews Business School Research Bursary of £1000 for research expenses. If you are planning to apply for this project, first contact the supervisors, contact Dr Joanne Cecil ([email protected]), Dr Javier Tello ([email protected]) and Dr Tugce Cuhadaroglu ([email protected], to discuss eligibility and obtain approval. Once an agreement is reached, you can proceed to submit your formal application.