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Life sciences · Review
Artefactum · September 30, 2026
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Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder in which reproductive dysfunction and metabolic abnormalities frequently coexist, making infertility assessment inseparable from cardiometabolic risk stratification. This narrative review aimed to analyze how insulin resistance, hyperandrogenism, adiposity, dysglycemia and related metabolic disturbances interact with ovulatory dysfunction and fertility outcomes, while discussing the clinical implications of current therapeutic evidence. Searches were conducted in 2026 in PubMed/MEDLINE and the Cochrane Library, complemented by the 2023 International Evidence-based Guideline for PCOS. Evidence from guidelines, systematic reviews, meta-analyses, randomized trials and robust observational studies was prioritized. The literature indicates that PCOS is associated with increased risk of impaired glucose regulation and adverse lipid and cardiovascular risk profiles even when obesity is absent, although body weight can amplify these abnormalities. Metabolic dysfunction contributes to hyperandrogenism and follicular arrest, but improvement in surrogate metabolic markers does not automatically translate into higher live birth rates. For anovulatory infertility without other major factors, letrozole has the strongest support as first-line pharmacological ovulation induction. Preconception management should integrate metabolic optimization, individualized fertility treatment and surveillance for pregnancy complications. Thus, metabolic and reproductive care should be understood as complementary dimensions of the same syndrome rather than separate therapeutic targets.