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That excess insulin triggers a cascade: the ovaries are overstimulated to produce androgens, the hypothalamic-pituitary axis loses its normal rhythm, and ovulation becomes irregular or absent

Then, missing values were imputed from normal distribution by calculating width and center of the distribution

Apr 28th, 2026 Kisspeptin and fertility regulation explained Kisspeptin is a peptide that regulates the reproductive axis by stimulating GnRH and sex hormone release, showing potential for fertility and libido, but it is not FDA-approved and lacks robust clinical evidence

10.1016/s0925-4927(99)00052-9 12 BermanS

Garvey WT et al., SURMOUNT-2, Lancet 2023 : tirzepatide in obese diabetic patients with type 2 diabetes