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Research into the pathogenesis of PCOS remains limited (9), but current evidence highlights a notable association between hormonal fluctuations and PCOS pathogenesis, particularly in the levels of insulin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), androgens, estrogens, and progesterone (10) (Figure 1)
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Balancing the ratio allows the activity of the enzyme pyruvate dehydrogenase to be maintained because acetyl-CoA production will match acetyl-CoA entrance into the TCA cycle, allowing more pyruvate to be shuttled into the mitochondria without being reduced to lactate (30, 31)
