The central importance of insulin resistance in the pathophysiology of polycystic ovary syndrome (PCOS) has been established by pioneering and elegant studies. In addition to the known hormonal and reproductive abnormalities that characterize this syndrome, metabolic disorders, as well as morbidities such as the enhanced risk for type 2 diabetes and increased risk for cardiovascular disease, have also been demonstrated. Current therapeutic approaches justifiably include insulin-sensitizing agents promising to comfort women with PCOS. Management with insulin sensitizers appears to embrace beneficially in a global fashion several aspects of the syndrome and target most of the associated metabolic and reproductive consequences.