Abstract
Background: Indeed, insulin resistance is at the center of the metabolic pattern of PCOS and could be implicated in disorders of ovulation. The aim of the present study was to investigate the relationship between IR, as estimated by HOMA-IR, and ovulation in women with PCOS. Methods: A cross-sectional design recruited 97 women with PCOS from gynecology clinics across Babylon Governorate, Iraq. Each woman was offered a clinical and biochemical assessment, including BMI, waist-to-hip ratio, fasting glucose and insulin levels, HOMA-IR, testosterone, SHBG, and mid-luteal progesterone. Ovulatory status was defined by progesterone levels and follicular activity. Data analysis included descriptive statistics, Pearson correlation, logistic regression, and intergroup comparisons. Results: In the present group, ovulatory cycles were present in 41%, whereas the other 59% of the women showed anovulation. HOMA-IR inversely correlated with mid-luteal progesterone levels (r = -0.52, p < 0.001) and ovulatory status (r = -0.48, p < 0.001). HOMA-IR positively correlated with BMI (r = 0.56, p < 0.001) and testosterone (r = 0.42, p < 0.001). When included as a logistic regression, HOMA-IR emerged as a significant predictor of anovulation (OR = 2.34, 95% CI: 1.53 to 3.57, p < 0.001). Women who were anovulatory were found to have increased levels of HOMA-IR and testosterone and reduced levels of SHBG compared to women who ovulated. Conclusion: Insulin resistance is an important factor in determining ovulation dysfunction in women with polycystic ovary syndrome. Targeted assessment and management of insulin resistance is recommended to improve ovulation and reproductive outcomes.

Key words: Polycystic Ovary Syndrome, Insulin Resistance, Ovulatory Dysfunction, HOMA-IR.