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For couples undergoing a pregnancy program (promil), fertility medications can be one of the ways to increase the chance of conception

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Left untreated, too little vitamin B12 can ultimately lead to nerve damage, ataxia (difficulty with walking and balance), pernicious anemia, heart failure, and even gastric cancer, Swenor says

Treatment considerations include: Concurrent folate supplementation if deficient (never give folate alone, as it may precipitate neurological deterioration) Potassium monitoring during initial treatment in severe anaemia or at-risk patients (e.g., those with heart failure) Response assessment: reticulocyte count peaks at 57 days, haemoglobin normalises within 68 weeks Neurological symptoms may take 612 months to improve and may not fully resolve Patients should be advised that treatment for pernicious anaemia or post-surgical deficiency is lifelong

This is adequate for peripheral metabolic effects like appetite suppression and insulin sensitization, but it may limit the full potential of central GLP-1 receptor activation