INS and obesity due to melanocortin 4 receptor deficiency: PCOS women with IR had higher frequencies of menstrual irregularity, hyperandrogenism, infertility or subfertility and obesity [37], Homeostasis mode assessment estimated insulin resistance (HOMA-IR ) more accurate than fasting insulin for evaluating PCOS women [37], so a further assessment of the effect of GA on the insulin status of PCOs patients is needed.