The effect of glucagon-like peptide-1 receptor agonists versus metformin on pregnancy rates in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized trials

IF 2.3 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2026-12-01 Epub Date: 2026-10-15 DOI:10.1016/j.ejogrb.2026.115499

Emre Kar, John Yeh, Mehtap Akın Efe, Hale Göksever Çelik, Gürkan Bozdağ, Ercan Baştu

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引用次数: 0

Abstract

Background

PCOS-related infertility is closely linked to metabolic dysfunction. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve insulin resistance and promote weight loss in women with PCOS, but their direct effect on reproductive outcomes remains uncertain.

Objectives

To evaluate whether GLP-1RA-based therapy improves pregnancy outcomes in women with PCOS.

Search strategy

PubMed, Scopus, and Web of Science were searched from inception to February 2026.

Selection criteria

Randomized controlled trials comparing GLP-1RA-based therapy, alone or combined with metformin, with metformin monotherapy in women with PCOS.

Data collection and analysis

Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2. Dichotomous outcomes were pooled as odds ratios with 95% confidence intervals using a random-effects model. Certainty of evidence was rated with GRADE, and trial sequential analysis was performed.

Main results

Four reports from three randomized trials (252 participants) were included. GLP-1RA-based treatment did not significantly improve overall pregnancy (OR 1.41, 95% CI 0.81–2.45), but was associated with an increase in natural pregnancy (OR 3.10, 95% CI 1.74–5.49), with no significant effect on IVF pregnancy (OR 1.01, 95% CI 0.36–2.85). TSA supported the finding for natural pregnancy, while evidence for overall pregnancy remained underpowered. Certainty of evidence was moderate for natural pregnancy and low for the other outcomes.

Conclusions

GLP-1 receptor agonists show promising preliminary signals for improving spontaneous conception in women with PCOS, but the available evidence remains limited. Current evidence is insufficient to draw conclusions regarding IVF outcomes. Larger trials with standardized endpoints, including live birth, are needed.

查看原文本刊更多论文

胰高血糖素样肽-1受体激动剂与二甲双胍对多囊卵巢综合征妇女妊娠率的影响：随机试验的系统回顾和荟萃分析

背景：pcos相关性不孕与代谢功能障碍密切相关。胰高血糖素样肽-1受体激动剂（GLP-1RAs）可改善PCOS女性的胰岛素抵抗并促进体重减轻，但其对生殖结局的直接影响尚不确定。目的：评价glp - 1ra为基础的治疗是否能改善PCOS患者的妊娠结局。搜索策略：PubMed， Scopus和Web of Science从成立到2026年2月进行了搜索。选择标准：随机对照试验比较glp - 1ra为基础的治疗，单独或联合二甲双胍，与单用二甲双胍治疗多囊卵巢综合征的妇女。数据收集和分析：两位审稿人独立筛选研究，提取数据，并使用RoB 2评估偏倚风险。使用随机效应模型将二分类结果合并为95%置信区间的比值比。证据的确定性用GRADE评分，并进行试验序列分析。主要结果：纳入了来自3个随机试验（252名受试者）的4份报告。基于glp - 1ra的治疗没有显著改善总妊娠（OR 1.41, 95% CI 0.81-2.45），但与自然妊娠增加相关（OR 3.10, 95% CI 1.74-5.49），对体外受精妊娠无显著影响（OR 1.01, 95% CI 0.36-2.85）。运输安全管理局支持自然妊娠的发现，而总体妊娠的证据仍然不足。自然妊娠的证据确定性中等，其他结局的证据确定性较低。结论：GLP-1受体激动剂在改善PCOS妇女自然受孕方面显示出有希望的初步信号，但现有证据仍然有限。目前的证据不足以得出关于体外受精结果的结论。需要有标准化终点的更大规模试验，包括活产。

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.