Glucagon-Like Peptide-1 Receptor Agonists in Polycystic Ovary Syndrome: Metabolic Preconditioning and Reproductive Implications

Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility and it is frequently linked to obesity and insulin resistance. Metabolic dysfunction is a major cause of ovarian androgen excess and disrupted folliculogenesis. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been commonly reported as a treatment option for obesity and metabolic disease, recently gaining attention for their reproductive relevance in women with PCOS. This narrative review is based on evidence from randomized controlled trials, meta-analyses, and mechanistic studies on metabolic and fertility outcomes. The findings are based on a literature review in which clinically relevant weight loss and improvement in insulin sensitivity are often accompanied by restoration of the menstrual cycle. Evidence suggesting enhanced ovulatory activity and increased pregnancy rates appears promising, but is based on studies not primarily aimed at measuring fertility endpoints. The live birth outcomes and information on the benefit of assisted reproductive technology remain limited. In general, GLP-1 RAs are likely to be most accurately considered as agents to optimize preconception metabolism rather than primary fertility treatment. More well-designed phenotype-stratified studies incorporating standardized reproductive endpoints including live birth are needed to determine their role in reproductive medicine.