The polycystic ovary syndrome (PCOS) is a common cause of anovulatory infertility. It is diagnosed by the presence of hyperandrogenemia, insulin resistance (IR), obesity and other endocrine or metabolic disorders. Exenatide (EX) is a kind of glucagon-like peptide, which is a new option for patients with diabetes mellitus. We present a patient with infertility for PCOS. She was overweight and her medical history included IR, right-sided ovarian mucinous cystadenomas, and left-sided teratoma. Although she had been treated with ovarian surgery, clomiphene citrate and gonadotropins, weight loss and metformin, which have been effective for dominant follicle development, she still failed to conceive. Then EX was initiated to intervene for 2 months. EX treatment was successful to improve IR; after that the infertile woman with PCOS became pregnant. EX improves IR and reproduction capacity in PCOS patients, reducing insulin level and ameliorating endocrine disorders, thereby improving ovarian function, promoting follicle development, and providing new avenues for the treatment of infertility with PCOS.

Keywords:
Polycystic ovary syndrome, Insulin resistance, Infertility, Exenatide, Metformin
1.
Wu H, Sui C, Xu H, Xia F, Zhai H, Zhang H, Weng P, Han B, Du S, Lu Y: The GLP-1 analogue exenatide improves hepatic and muscle insulin sensitivity in diabetic rats: tracer studies in the basal state and during hyperinsulinemic-euglycemic clamp. J Diabetes Res 2014;2014:524517.
2.
Sonntag B, Götte M, Wülfing P, Schüring AN, Kiesel L, Greb RR: Metformin alters insulin signaling and viability of human granulosa cells. Fertil Steril 2005;84(suppl 2):1173-1179.
3.
Nestler JE, Jakubowicz DJ, de Vargas AF, Brik C, Quintero N, Medina F: Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. J Clin Endocrinol Metab 1998;83:2001-2005.
4.
Loukovaara M, Carson M, Adlercreutz H: Regulation of production and secretion of sex hormone-binding globulin in HepG2 cell cultures by hormones and growth factors. J Clin Endocrinol Metab 1995;80:160-164.
5.
Pasquali R, Gambineri A, Pagotto U: The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG 2006;113:1148-1159.
6.
Franks S, Gilling-Smith C, Watson H, Willis D: Insulin action in the normal and polycystic ovary. Endocrinol Metab Clin North Am 1999;28:361-378.
7.
Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society: Diagnosis and treatment of polycystic ovary syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2013;98:4565-4592.
8.
Pappachan JM, Raveendran AV, Sriraman R: Incretin manipulation in diabetes management. World J Diabetes 2015;6:774-781.
9.
Holst JJ: Incretin hormones and the satiation signal. Int J Obes (Lond) 2013;37:1161-1168.
10.
Ross SA, Ekoé JM: Incretin agents in type 2 diabetes. Can Fam Physician 2010;56:639-648.
11.
Elkind-Hirsch K, Marrioneaux O, Bhushan M, Vernor D, Bhushan R: Comparison of single and combined treatment with exenatide and metformin on menstrual cyclicity in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab 2008;93:2670-2678.
12.
Jensterle Sever M, Kocjan T, Pfeifer M, Kravos NA, Janez A: Short-term combined treatment with liraglutide and metformin leads to significant weight loss in obese women with polycystic ovary syndrome and previous poor response to metformin. Eur J Endocrinol 2014;170:451-459.
13.
Liu Z, Stanojevic V, Brindamour LJ, Habener JF: GLP1-derived nonapeptide GLP1(28-36)amide protects pancreatic β-cells from glucolipotoxicity. J Endocrinol 2012;213:143-154.
14.
Lee YS, Park MS, Choung JS, Kim SS, Oh HH, Choi CS, Ha SY, Kang Y, Kim Y, Jun HS: Glucagon-like peptide-1 inhibits adipose tissue macrophage infiltration and inflammation in an obese mouse model of diabetes. Diabetologia 2012;55:2456-2468.
15.
Orvieto R, Meltcer S, Liberty G, Rabinson J, Anteby EY, Nahum R: Does day-3 LH/FSH ratio influence in vitro fertilization outcome in PCOS patients undergoing controlled ovarian hyperstimulation with different GnRH-analogue? Gynecol Endocrinol 2012;28:422-424.
16.
Tao X, Ge SJ, Chen J, Xing W, Gu J, Zhang X: Effect of exenatide on insulin resistance and reproductive hormone in polycystic ovary syndrome rats. J Sun Yat Univ (Med Sci) 2014;35:844-848, 853.
© 2016 S. Karger AG, Basel
2016
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