Emerging Therapeutic Strategies for Polyendocrine Metabolic Ovarian Syndrome

Polycystic ovary syndrome, now renamed as Polyendocrine Metabolic Ovarian Syndrome (PMOS), affects more than one in ten women of reproductive age and remains the leading cause of anovulatory infertility. Management has changed little in two decades: letrozole or clomiphene for ovulation induction, metformin for insulin resistance, lifestyle advice for weight management, and assisted reproduction when these fail. Incretin-based therapies, including GLP-1 receptor agonists and dual GIP/GLP-1 agonists, together with structured lifestyle programs, now achieve degrees of metabolic and androgen improvement that were not previously possible, and early reports suggest they can restore ovulatory cycles. The reproductive evidence base, however, lags well behind the metabolic one. Little is known about how these agents affect oocyte quality, endometrial receptivity, response to ovarian stimulation or live birth rates, how long a pre-conception washout should be, or which patients benefit most. Most trials use metabolic endpoints and exclude women trying to conceive.This Research Topic aims to move PMOS treatment research from metabolic surrogates towards reproductive outcomes. We invite evidence on how current and emerging therapies act on the ovary, the endometrium and the fertility trajectory of women with PMOS: incretin-based pharmacotherapy, insulin sensitizers, anti-androgens, ovulation induction protocols, structured lifestyle and weight management programs, and combinations of these. We are interested in both mechanism and outcome. On one side, studies clarifying how correction of insulin resistance and hyperandrogenemia translates into follicular development, oocyte competence, implantation and pregnancy. On the other, clinical work reporting ovulation, conception, IUI and IVF outcomes, focusing on live birth and obstetric endpoints. We also want the questions clinicians face daily to be addressed with data: treatment sequencing and washout before conception, safety in early pregnancy, management of adolescents and of the lean phenotype, and equity of access to effective therapy. The aim is a collection that gives reproductive endocrinologists a firmer evidence base for treating PMOS, and that defines the trials the field still needs.Contributions must show a clear connection to reproductive physiology or reproductive outcomes; studies with purely metabolic or weight-related endpoints fall outside the scope of the Reproduction section. We welcome work on:• GLP-1 and dual incretin receptor agonists in PMOS: effects on ovulation, androgen profile, fertility, pregnancy outcomes, pre-conception washout and safety• Insulin sensitizers, anti-androgens and combination pharmacotherapy• Ovulation induction and assisted reproduction protocols tailored to PMOS phenotypes• Structured lifestyle, nutrition and exercise interventions assessed against reproductive endpoints• Mechanistic studies, including animal and cell models, linking metabolic and androgen correction to oocyte quality, the follicular environment, endometrial receptivity and implantation• Treatment of adolescents and of the lean phenotype; long-term reproductive and offspring outcomes• Disparities in access to effective PMOS treatment and fertility careTopic Editor Pardis Hossienzadeh is a Medical Consultant for Eli Lilly. The other Topic Editors declare no competing interests with regard to the Research Topic subject. Topic editors: Samantha Schon, Pardis Hosseinzadeh Source: https://www.frontiersin.org/research-topics/84691/emerging-therapeutic-strategies-for-polyendocrine-metabolic-ovarian-syndrome