INS and obesity due to melanocortin 4 receptor deficiency: Women with obesity undergoing in vitro Fertilization (IVF) have an altered follicular environment with higher levels of insulin, markers of inflammation, and elevated levels of free fatty acids, which were correlated with abnormal cumulus-oocyte complexes (Robker et al., 2009; Jungheim et al., 2011; Leary et al., 2015; Caprio et al., 2015).