In addition, increased insulin levels in synergy with LH in granulosa cells from anovulatory polycystic ovaries might trigger premature LH receptor expression in a subpopulation of small follicles leading to premature granulosa terminal differentiation and the arrest of follicular growth that might contribute to anovulation in this subgroup [43, 44]. This evidence concerns the gene PLOD1 and polycystic ovary syndrome.