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The SELECT trial and subsequent renal subgroup analyses suggested that, in populations with both obesity and pre-existing cardiovascular disease, semaglutide not only reduced the risk of cardiovascular events but also slowed the decline of the estimated glomerular filtration rate (eGFR) ( As indications have expanded from diabetes to obesity, GLP-1RAs have increasingly entered routine care for women of reproductive age, including those with PCOS, in whom obesity and insulin resistance are highly prevalent ( 1.4 Rationalizing fertility-centered review of GLP-1RAs in PCOS: bridging metabolic-reproductive divide 1.4.1 Clinical paradox: tension between metabolic optimization and reproductive urgency While GLP-1RAs have been established as a first-line intervention for managing metabolic comorbidities in PCOS, their potential teratogenic risks and the requirement for strict preconception washout periods present a formidable clinical dilemma for reproductive specialists