Which metabolic feature is commonly associated with PCOS and may contribute to infertility?

• A. Insulin resistance
• B. Hypothyroidism
• C. Hyperprolactinemia
• D. Adrenal insufficiency

Answer: (A)

Insulin resistance is the metabolic abnormality most commonly seen in PCOS and it directly contributes to infertility. When tissues don’t respond well to insulin, the pancreas makes more insulin (hyperinsulinemia). This excess insulin stimulates ovarian theca cells to produce more androgens and lowers liver production of sex hormone-binding globulin, increasing free testosterone. Higher androgens disrupt normal follicle development and ovulation, leading to irregular menses and impaired fertility. Weight loss and therapies like metformin that improve insulin sensitivity can often restore more regular ovulatory cycles.

Other choices describe conditions that can cause infertility through hormonal disruption, but they are not the characteristic metabolic feature of PCOS. Hypothyroidism, hyperprolactinemia, and adrenal insufficiency can affect ovulation, but PCOS centers on insulin resistance as the key metabolic link to its infertility risk.