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9 Research gaps and future priorities 9.1 Reproductive-oriented RCTs: shifting from metabolic surrogates to hard endpoints To date, most GLP-1RA trials in PCOS have been designed around metabolic efficacy (weight change and insulin-resistance/glycaemic indices) as the primary outcomes, with reproductive outcomesovulation, clinical pregnancy, and live birthreported inconsistently and often as secondary or exploratory measures

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