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Its activity is controlled by insulin-like growth factor binding proteins and the insulin-like growth factor-1 receptor (IGFR) ( 2.9 Follistatin In the liver, the ratio of glucagon to insulin regulates the secretion of cyclic Follistatin (Fst) ( FST gene can lead to early infertility and arrest of follicular development, similar to conditions observed in PCOS ( 2.10 FGF21 The liver is the main source of circulating fibroblast growth factor 21 (FGF21) ( 2.10.1 In glucose metabolism ( 2.10.2 In lipid metabolism ( 2.10.3 The relation between FGF21 and PCOS FGF21 is an important regulator of lipids and glucose, which can reduce androgen levels and restore ovulation in PCOS patients by improving insulin sensitivity, promoting lipid metabolism and reducing body weight