INS and obesity due to melanocortin 4 receptor deficiency: The pathogenesis of PCOS remains poorly understood (33–36), and PCOS presents as a diverse and complicated syndrome involving reproductive dysfunction (infertility and menstrual irregularity), metabolic problems (dyslipidemia, obesity, increased insulin levels, and glucose intolerance), cardiovascular problems (coronary heart disease), psychological disorders (anxiety and depression), and sexual dysfunction (37–41).