The Relevance of Follicle Number and Androgens in Metabolic Alterations in Polycystic Ovary Syndrome: A Cross-Sectional Study

Background/Objectives: Polycystic Ovary Syndrome (PCOS) is characterized by reproductive and metabolic disturbances, including insulin resistance and altered ovarian morphology. The clinical manifestations of PCOS include metabolic, reproductive, and psychological issues that negatively affect quality of life, making PCOS a significant public health concern. The relationship between follicle number and metabolic alterations across PCOS phenotypes still remains unclear. Methods: We conducted a retrospective cross-sectional study of 289 PCOS patients and 50 controls, assessing insulin resistance, lipid profiles, ovarian volume, and follicle count across phenotypes A, B, and C. We compared the three PCOS phenotypes and identified differences in follicle number, ovarian volume, insulin-related biomarkers, androgens, and LH and FSH. Results: Phenotype A exhibited higher insulin resistance and adverse lipid profiles compared to controls. The follicle number significantly discriminated between phenotypes and is associated with insulin-related alterations, one of the most clinically relevant aspects of PCOS. It is also correlated negatively with insulin resistance, most notably in phenotype B. Ovarian volume even differed among phenotypes but showed weaker metabolic associations. There is also a significant relevance of ovarian dysmorphology in PCOS and its association with hyperinsulinemia and insulin resistance. Conclusions: There is a complex interplay among the ovarian morphology, androgen and metabolic patterns in the different PCOS phenotypes. Follicle number is a relevant marker linked to insulin resistance in PCOS, particularly in phenotype B, supporting its role in clinical phenotyping and potential for guiding personalized management strategies.