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Consequently, PCOS patients frequently exhibit elevated serum iron, ferritin, and transferrin saturation, indicative of a systemic iron-overloaded state ( Iron deficiency, in turn, disrupts glucose homeostasis and promotes IR, thereby forming a vicious cycle with the metabolic disturbances characteristic of PCOS ( 3.2 Ovarian granulosa cell ferroptosis and impaired follicular development Granulosa cells are the primary site of ovarian hormone synthesis and play a crucial role in regulating follicular development, oocyte maturation, and ovulation through hormone secretion