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In a double-blind, randomized trial of 44 metformin-treated patients with T2DM, neither dapagliflozin nor gliclazide significantly altered gut microbiome composition over 12 weeks, despite exhibiting divergent metabolic effects such as reduced weight and fasting insulin with dapagliflozin and increased insulin with gliclazide [40]

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In the meantime, she said, clinicians will need shared, informed decision making with our patients. And although there is the possibility of combining these different treatments, she stressed, combinations have not yet proven to be beneficial and should not be offered outside of a clinical trial.

While treatments like IVF and IUI remain central to fertility care, GLP-1 receptor agonists have entered the discussion as a potential new tool, especially for patients with PCOS, insulin resistance, or weight-related fertility concerns