Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated efficacy in improving glycemic control and promoting weight loss in individuals with type 2 diabetes. Recent studies suggest that semaglutide may also exert beneficial effects on reproductive physiology, particularly in women with polycystic ovary syndrome (PCOS). This review provides a comprehensive summary of the current evidence on the effects of semaglutide on fertility. We examine its mechanisms of action on insulin sensitivity, hormone regulation, and ovarian function, highlighting the potential benefits for women with PCOS. The review also discusses the potential risks and limitations of using semaglutide as a fertility treatment, including its unknown effects on pregnancy and lactation. The evidence suggests that semaglutide may improve fertility outcomes in women with PCOS by enhancing insulin sensitivity, regulating hormone levels, and promoting weight loss. However, further research is needed to fully elucidate the effects of semaglutide on reproductive health and to establish its safety and efficacy as a fertility treatment. This review aims to provide a comprehensive overview of the current evidence and to inform future research directions.