Glucagon-Like Peptide-1 Receptor Agonists in Polycystic Ovary Syndrome and Women’s Reproductive Health: Metabolic and Reproductive Effects and Preconception Strategies

Polycystic ovary syndrome (PCOS) and obesity frequently coexist and are strongly associated with anovulation, subfertility, pregnancy complications, and long-term cardiometabolic risk. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used in type 2 diabetes and obesity, are increasingly being considered in women of reproductive age. Growing evidence suggests that these agents may affect both metabolic and reproductive outcomes, raising important questions about their role in PCOS management, preconception care, and pregnancy safety. This narrative, concept-driven review evaluates the role of GLP-1 RAs in women’s reproductive health. Major medical databases were searched for studies published within the past 10 years, with emphasis on randomized controlled trials, large observational cohorts, and systematic reviews. In randomized trials involving women with PCOS, GLP-1 RAs have shown clinically meaningful weight loss, improved insulin resistance, and reduced androgen excess. Several studies also reported improved menstrual regularity, ovulation-related outcomes, and conception rates compared with metformin alone. Emerging preconception data suggest that GLP-1-induced weight reduction may improve readiness for spontaneous conception and assisted reproductive techniques. Human pregnancy exposure data remain limited. Available registry and case-series findings have not shown a clear teratogenic signal, but sample sizes are small. The observational nature of pregnancy safety data also limits causal inference. Additionally, evidence from obesity trials suggests that metabolic benefits may decline after treatment discontinuation due to weight regain, which may affect preconception strategies. Overall, GLP-1 RAs appear promising as adjunctive therapy for women with PCOS and obesity, but current evidence is insufficient to support routine use during pregnancy.