Polycystic ovary syndrome (PCOS) is a common cause of anovulation and a frequent cause of subfertility. Additionally, it is associated with metabolic complications such as insulin resistance. Metformin is an insulin sensitiser, acting through several mechanisms including inhibition of gluconeogenesis and lipogenesis, reduction in hepatic glucose output and optimisation of insulin-mediated skeletal muscle glucose uptake. Exenatide is a glucagon-like peptide-1 receptor agonist that reduces hepatic gluconeogenesis and augments skeletal muscle glucose uptake, thereby reducing insulin resistance.

Li and colleagues report long term outcomes from a single-centre, randomised controlled trial. Here, 160 overweight patients (body mass index>24kg/m2) with PCOS, who were aged 20–40 years and had a history of two years of anovulatory infertility, received either metformin or exenatide for 12 weeks. All patients then continued on metformin alone and were advised to attempt spontaneous conception. If this did not occur within a further 12 weeks, patients were offered assisted reproductive technology until the end of 64 weeks. The primary outcome was pregnancy rate.

Preconception treatment with 12 weeks of exenatide resulted in more spontaneous pregnancies compared with metformin, and exenatide was associated with greater improvement in insulin resistance as determined by HOMA-IR. These findings are interesting, but further research across more sites is needed before they can be generalised.

Read the full article in Archives of Gynecology and Obstetrics doi: 10.1007/s00404-022-06700-3