Zaher Merhi’s research while affiliated with Albert Einstein College of Medicine and other places

Purpose of review The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is on the rise and their impact on reproductive health in healthy women without polycystic ovary syndrome (PCOS) remains unclear. This review provides a critical analysis of existing data about their impact on reproduction in non-PCOS state. Recent findings To date, studies in animal models have been very heterogeneous using different models (rats versus mice) and different types of GLP-1 RAs (liraglutide versus exendin-4 versus dulaglutide), with variable modes of administration (subcutaneous versus intracerebral) and variable duration/dose of administration. In the ovaries, GLP-1 RA caused lower ovarian weights, more follicular atresia, and a drop in serum steroid levels. In the hypothalamus, GLP-1 RA caused downregulation in kiss-1 and kiss-1r expression leading to lower serum luteinizing hormone levels and delay in puberty. In the uterus, GLP-1 RAs caused a negative impact on the epithelium, however, in the intrauterine adhesion mouse model, they lowered uterine fibrosis. No human studies to examine the effect of GLP-1 RAs on fertility in women without PCOS have been published. Summary Further research is essential to understand the impact of GLP-1 RA in non-PCOS women, especially because many reproductive-aged women without PCOS are using these medications for weight loss.

Problem Exposures during the perinatal period, a phase of rapid development and growth, may have a profound and sustained effect on metabolic disturbances later in life. The pro‐inflammatory advanced glycation end products (AGEs) are widely consumed in the Western diet. The purpose of this study was to determine whether perinatal exposure to these dietary AGEs alters metabolic parameters, in particular adiposity and glucose hemostasis, in male mice offspring. Methods Seven‐week‐old female CD1 mice were placed before mating and then throughout pregnancy and lactation on either a low AGE (L‐AGE; n = 13) or high AGE (H‐AGE; n = 13) diet. All offspring in both groups were weaned postnatal day 21 onto normal diet and studied through to 21 weeks of age. The offspring were counted and weighed weekly, starting at birth until 21 weeks of age, to assess the growth curve. At the time of sacrifice, Echo MRI was performed to measure adiposity and to record liver, white epididymal adipose tissue (WAT), and inguinal fat weights. Serum levels of leptin as well as insulin and glucose tolerance tests (ITT and GTT) were compared. Results The Body weight at birth of offspring of dams that were on H‐AGE diet was significantly lower compared to the body weight of offspring of dams that were on L‐AGE diet. Echo MRI data showed that the offspring of dams that were H‐AGE diet had significantly lower fat mass, lower epididymal WAT fat weight, and lower inguinal fat weight but higher lean body mass and similar liver weight. They also had significantly higher glucose levels during GTT and ITT, as well as significantly lower serum leptin levels compared to the offspring of dams that were on the L‐AGE diet. Conclusions These results indicate that perinatal exposure to a maternal diet elevated in AGEs causes deficits in perinatal growth and impairment in glucose hemostasis in male mice. These findings suggest that AGEs may represent an important new class of mediators of adiposity and the metabolic syndrome.

There are racial disparities in access and outcomes of assisted reproductive technology treatment in the USA; however, the effect of the pandemic on racial disparity within reproductive healthcare has not been extensively studied. This study aimed to identify how the pandemic has affected patient decision-making regarding fertility planning and treatment among Black versus non-Black women. The decision-making parameters that were assessed included discontinuing or changing the fertility treatment plans as well as visits to the clinic. This is a cross-sectional questionnaire study that was conducted at a university-affiliated fertility clinic between January and December 2021. A link to a survey was emailed to patients who were asked to fill out a questionnaire regarding fertility plans prior to and during the pandemic, in particular, the choice of the type of fertility treatment, exposure to COVID-19, and acceptability of the vaccine while trying to conceive, canceling or postponing the fertility treatment, and the use of telehealth during the pandemic. Out of 223 patients, the majority reported that the pandemic did not change their plans, and the minority reported either postponing or canceling their treatments with financial instability being the most reported reason. Fewer Black women were vaccinated compared to non-Black women. When asked whether the pandemic was well-handled by major healthcare systems, Black women were less likely than non-Black women to think that it met expectations. Additionally, Black women were less likely to be comfortable visiting fertility clinics in person and less interested in future at-home monitoring, if available, compared to non-Black women. Thus, among women undergoing fertility treatments during the pandemic, Black individuals were associated with a lower percentage of being vaccinated, a lower percentage of being satisfied with major healthcare systems handling the pandemic, and lesser comfort in visiting the fertility clinic physically. There is a clear need to understand the underlying reasons as to why the pandemic contributed to a racial disparity in fertility treatments.