Backgrounds: Polycystic ovary syndrome is the most common endocrine and reproductive disorder in the reproductive-age women. Among the pathological changes that are responsible for the development of polycystic ovary syndrome (PCOS), hyperinsulinemia due to increased insulin resistance (IR) is common and usually associated with a higher rate of ovulatory dysfunction and sub-fertility. In addition, those women have poor quality oocytes with low fertilization capability and poor quality embryos. So, insulin has a role in the reproductive function and fertility potential of reproductive age women. Conclusion: Females with PCOS usually exhibit an extreme difficulty in achieving either a successful spontaneous or assisted pregnancy. Hyperinsulinemia / insulin resistance and reproductive dysfunction should be well understood as can as possible in order to achieve an effective treatment plan to increase the chance of a successful uncomplicated pregnancy.


  1. Lee I, Vresilovic J, Irfan M, Gallop R, Dokras A. Higher incidence of metabolic syndrome in Black women with polycystic ovary syndrome: a longitudinal study. J Clin Endocrinol Metab 2022 Apr;107(4):e1558e67. https://doi.org/10.1210/clinem/dgab840.
  2. Peigne M, Dewailly D. Long term complications of polycystic ovary syndrome (PCOS). Ann Endocrinol 2014 Sep 1;75(4):194e9. Elsevier Masson. https://doi.org/10.1016/j.ando.2014.07.111.
  3. Palomba S, Daolio J, La Sala GB. Oocyte competence in women with polycystic ovary syndrome. Trends Endocrinol Metabol 2017 Mar 1;28(3):186e98. https://doi.org/10.1016/j.tem.2016.11.008.
  4. Hassan MF, Al-yasiry RZ. HOW polycystic ovary syndrome (PCOS) affects the fertility potential of reproductive age females. Global J Med Publ Health 2019 Nov 1;1(2):77e84. https://doi.org/10.37557/gjphm.v1i2.21.
  5. Sakumoto T, Tokunaga Y, Tanaka H, Nohara M, Motegi E, Shinkawa T, et al. Insulin resistance/hyperinsulinemia and reproductive disorders in infertile women. Reproductive Med Biol 2010 Dec;9(4):185e90. https://doi.org/10.1007/s12522-010-0062-5.
  6. Mekaru K, Oishi S, Akamine K, Kinjo T, Heshiki C, Masamoto H, et al. The effect of insulin resistance on in-vitro fertilization-embryo transfer in women without polycystic ovary syndrome. Open J Obstet Gynecol 2016 Mar 1;6(3):157e66. https://doi.org/10.4236/ojog.2016.63020.
  7. Miceli DD, Vidal PN, Batter MF, Pignataro O, Castillo VA. Metformin reduces insulin resistance and the tendency toward hyperglycaemia and dyslipidaemia in dogs with hyperadrenocorticism. Open Vet J 2018 May 30;8(2):193e9. https://doi.org/10.4314/ovj.v8i2.13.
  8. Kubota T. Update in polycystic ovary syndrome: new criteria of diagnosis and treatment in Japan. Reproductive Med Biol 2013 Jul;12(3):71e7. https://doi.org/10.1007/s12522-013-0145-1.
  9. Al-Samerria S, Radovick S. The role of insulin-like growth factor-1 (IGF-1) in the control of neuroendocrine regulation of growth. Cells 2021 Oct 5;10(10):2664. https://doi.org/10.3390/cells10102664.
  10. Hoang V, Nguyen H, Nguyen V, Hoang D, Nguyen T. Adipose-derived mesenchymal stem cell therapy for the management of female sexual dysfunction: literature reviews and study design of a clinical trial. Front Cell Dev Biol 2022 Jan 1:10. https://doi.org/10.3389/fcell.2022.956274.
  11. Notaro ALG, Neto FTL. The use of metformin in women with polycystic ovary syndrome: an updated review. J Assist Reprod Genet 2022;39:573e9. https://doi.org/10.1007/s10815-022-02429-9.
  12. Almasi-Hashiani A, Mansournia MA, Sepidarkish M, Vesali S, Ghaheri A, Esmailzadeh A, et al. Comparison of in vitro fertilization/intracytoplasmic sperm injection cycle outcome in patients with and without polycystic ovary syndrome: a modified Poisson regression model. Int J Fertil Steril 2018 Jan;11(4):309.https://doi.org/10.22074/ijfs.2018.5117.
  13. Moini A, Rezaee T, Aleyasin A, Arabipoor A, Moayed ME. The effect of metabolic syndrome on controlled ovarian stimulation outcome in infertile women with polycystic ovary syndrome undergoing assisted reproductive technology cycles.Archives of Endocrinology and Metabolism 2022 Oct 3.https://doi.org/10.20945/2359-3997000000518.
  14. Wang H, Zhang Y, Fang X, Kwak-Kim J, Wu L. Insulin resistance adversely affect IVF outcomes in lean women without PCOS.Front Endocrinol 2021;12.https://doi.org/10.3389/fendo.2021.734638.
  15. Shang Y, Zhou H, Hu M, Feng H. Effect of diet on insulin resistance in polycystic ovary syndrome.J Clin Endocrinol Metab 2020 Oct;105(10):3346e60.https://doi.org/10.1210/clinem/dgaa425.
  16. Mirghafourvand M, Charandabi SM, Lak TB, Aliasghari F. Relationship between healthpromoting lifestyle and quality of life in women with polycystic ovarian syndrome.Int J Wom Health and Reproduc Sci 2017 Oct 1;5(4):318e23.https://doi.org/10.1007/s40618-015-0429-x.
  17. Stepto NK, Moreno-Asso A, McIlvenna LC, Walters KA, Rodgers RJ. Molecular mechanisms of insulin resistance in polycystic ovary syndrome: unraveling the conundrum in skeletal muscle?J Clin Endocrinol Metab 2019 Nov;104(11):5372e81.https://doi.org/10.1210/jc.2019-00167.
  18. Gad M, Elbaz HT, El-Razek A, Zaghloul A, Genedy T. Different therapeutic approaches for treatment of cystic ovarian disease (COD) and its effect on conception rate in holstein dairy cows. J Curr Veter Res 2022 Apr 1;4(1):175-181. https://doi.org/10.21608/jcvr.2022.240924.
  19. Amisi CA. Markers of insulin resistance in Polycystic ovary syndrome women: an update. World J Diabetes 2022 Mar 15;13(3):129. https://doi.org/10.4239/wjd.v13.i3.129.
  20. Scannell N, Moran L, Mantzioris E, Cowan S, Villani A. Efficacy, feasibility and acceptability of a mediterranean diet intervention on hormonal, metabolic and anthropometric measures in overweight and obese women with polycystic ovary syndrome: study protocol. Metabolites 2022 Mar 31;12(4):311. https://doi.org/10.3390/metabo12040311.
  21. Kazemi M, Pierson RA, Parry SA, Kaviani M, Chilibeck PD. Obesity, but not hyperandrogenism or insulin resistance, predicts skeletal muscle mass in reproductive-aged women with polycystic ovary syndrome: a systematic review and meta-analysis of 45 observational studies. Obes Rev 2021 Aug;22(8):e13255. https://doi.org/10.1111/obr.13255.
  22. Hu S, Xu B, Long R, Jin L. The effect of polycystic ovary syndrome without hyperandrogenism on pregnancy-related outcomes: a retrospective cohort study. BJOG An Int J Obstet Gynaecol 2021 May;128(6):1003-1010. https://doi.org/10.1111/1471-0528.16577.
  23. Ashkar F, Rezaei S, Salahshoornezhad S, Vahid F, Gholamalizadeh M, Dahka SM, et al. The Role of medicinal herbs in treatment of insulin resistance in patients with Polycystic Ovary Syndrome: a literature review. Biomol Concepts 2019 Jan 1;11(1):57-75. https://doi.org/10.1515/bmc-2020-0005.
  24. Brown DL, Henrichsen TL, Clayton AC, Hudson SB, Coddington III CC, Vella A. Ovarian stromal hyperthecosis: sonographic features and histologic associations. J Ultrasound Med 2009 May;28(5):587-593. https://doi.org/10.7863/jum.2009.28.5.587.
  25. Maqbool M, Dar MA, Gani I, Geer MI. Insulin resistance and polycystic ovary syndrome: a review. J Drug Deliv Therapeut 2019;9(1-s):433-436. https://doi.org/10.22270/jddt.v9i1-s.2275.
  26. Kumar AN, Naidu JN, Satyanarayana U, Ramalingam K, Anitha M. Metabolic and endocrine characteristics of Indian women with polycystic ovary syndrome. Int J Fertil Steril 2016 Apr-Jun;10(1):22-28. https://doi.org/10.22074/ijfs.2016.4764.
  27. Prasad B, Parmar D, Sharma NC. A study on serum FSH, LH and prolactin levels among infertile women. Int J Med Res Health Sci 2015;4(4):876-878. https://doi.org/10.5958/2319-5886.2015.00175.7.
  28. American Diabetes Association. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of Medical Care in Diabetesd2020.Diabetes Care 2020 Jan 1;43(Supplement_1):S37-S47.https://doi.org/10.2337/dc20-S004.
  29. Uysal S, Zeki Isik A, Eris S, Yigit S, Yalcin Y, Ozun Ozbay P.Correlation of endometrial glycodelin expression and pregnancy outcome in cases with polycystic ovary syndrome treated with clomiphene citrate plus metformin: a controlled study.Obstet Gynecol Int 2015 Feb 28:2015.https://doi.org/10.1155/2015/278591.
  30. Oldat-Stanković V, Popović-Pejić S, Stanković S, Prtina A, Malešević G, Bjekić-Macut J, et al.The effect of metformin and myoinositol on metabolic outcomes in women with polycystic ovary syndrome: role of body mass and adiponectin in a randomized controlled trial.J Endocrinol Invest 2022;45:583-595.https://doi.org/10.1007/s40618-021-01691-5.
  31. Stepto NK, Cassar S, Joham AE, Hutchison SK, Harrison CL,Goldstein RF, et al.Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulinaemic clamp.Hum Reprod 2013 Mar 1;28(3):777-784.https://doi.org/10.1093/humrep/des463.
  32. Soni A, Singla S, Goyal S.Polycystic ovary syndrome: pathogenesis, treatment and secondary associated diseases.J Drug Deliv Therapeut 2018 Sep 6;8(5):107-112.https://doi.org/10.22270/jddt.v8i5.1892.
  33. Karimi A, Tutunchi H, Naeini F, Vajdi M, Mobasseri M, Najafipour F. The therapeutic effects and mechanisms of action of resveratrol on polycystic ovary syndrome: a comprehensive systematic review of clinical, animal, and in vitro studies. Clin Exp Pharmacol Physiol 2022 Jul 2. https://doi.org/10.1111/1440-1681.13698.
  34. Niepsuj J, Franik G, Madej P, Piwowar A, Bizon A. Evaluation of pro/antioxidant imbalance in blood of women with polycystic ovary syndrome based on determination of oxidized low-density lipoproteins and ferric reducing ability of plasma values. Biomedicines 2022 Jul;10(7):1564. https://doi.org/10.3390/biomedicines10071564.
  35. Calcaterra V, Verduci E, Cena H, Magenes VC, Todisco CF, Tenuta E, et al. Polycystic ovary syndrome in insulin-resistant adolescents with obesity: the role of nutrition therapy and food supplements as a strategy to protect fertility. Nutrients 2021 Jun;13(6):1848. https://doi.org/10.3390/nu13061848.
  36. Barr S, Reeves S, Sharp K, Jeanes YM. An isocaloric low glycemic index diet improves insulin sensitivity in women with polycystic ovary syndrome. J Acad Nutr Diet 2013 Nov 1;113(11):1523-1531. https://doi.org/10.1016/j.jand.2013.06.347.
  37. Nestler JE, Stovall D, Akhter N, Iuorno MJ, Jakubowicz DJ. Strategies for the use of insulin-sensitizing drugs to treat infertility in women with polycystic ovary syndrome. Fertil Steril 2002 Feb 1;77(2):209-215. https://doi.org/10.1016/S0015-0282(01)02963-6.
  38. Miceli DD, Vidal PN, Batter MF, Pignataro O, Castillo VA. Metformin reduces insulin resistance and the tendency toward hyperglycaemia and dyslipidaemia in dogs with hyperadrenocorticism. Open Vet J 2018 May 30;8(2):193-199. https://doi.org/10.4314/ovj.v8i2.13.