Supervisors
Dr Joanne Cecil (School of Medicine), Dr Javier Tello (School of Medicine), and Dr Tugce Cuhadaroglu (Business School, Department of Economics)
Project description
Obesity disproportionately affects women of reproductive age and is associated with menstrual disturbances, subfertility, and adverse pregnancy outcomes. BMI thresholds (typically < 30 kg/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. Human data on periconceptional use remain limited. Current guidance therefore recommends discontinuing GLP-1 RAs before conception, although adherence to this guidance is variable. As a result, 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 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 associated with medication use and pregnancy outcomes, within the constraints of clinical guidelines and access policies.
The project has three research objectives:
- RO1: Synthesise evidence on GLP-1 RA effects on metabolic and ovarian biomarkers, periconceptional use, and pregnancy risks.
- RO2: Identify behavioural determinants of GLP-1 RA uptake and adherence during the periconceptional period among women with obesity, focusing on present bias, risk perceptions, informational constraints, and social norms.
- RO3: 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.
The student will conduct a structured evidence synthesis to quantify associations between GLP-1 RA use and reproductive biomarkers, and examine evidence on periconceptional use and obstetric outcomes (RO1). Semi-structured interviews with women of reproductive age living with obesity will explore decision-making processes, behaviours, and perceptions (RO2).
These components will feed into 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-1 RA use and treatment entry. It will evaluate alternative policy regimes, including BMI-based access restrictions, discontinuation guidance, and GLP-1 RA access, assessing implications for efficiency, equity, patient welfare, and clinical outcomes (RO3).
By integrating behavioural evidence, clinical data, and economic modelling, the project provides 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 and 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 a St Andrews Business School Research Bursary of £1000 for research expenses.
If you are planning to apply, please contact the supervisors first:
Applicants should discuss eligibility and obtain approval before submitting a formal application. Once agreement is reached, you may proceed with the application process.