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Actual out-of-pocket costs vary substantially based on insurance type, formulary tier placement, and whether the medication is prescribed for FDA-approved diabetes or weight management indications

The molecular mechanisms primarily involve excessive activation of the unfolded protein response triggered by endoplasmic reticulum stress in granulosa cells [350], leading to caspase cascade-dependent apoptosis, as well as DNA strand breaks and membrane lipid peroxidation induced by mitochondrial electron transport chain leakage in spermatozoa [351, 352]

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Chen WX, Chen YR, Peng MZ, Liu X, Cai YN, Huang ZF, et al