I was diagnosed with PCOS with Insulin Resistance in my early twenties. I absolutely loathe this affliction. I have taken a myriad of medications to combat it - including metformin and numerous different types of birth control pills. The metformin seemed to help a little bit but the gastric side effects were just horrible. I even switched to the extended release version and still suffered with gastric upset. I didn't think the minute benefits were worth being sick all the time so I stopped taking it. I also react badly to birth control pills. I guess it probably has something to do with the fact that my hormones are already out of whack but BC pills cause me to have 24/7 365 PMS. Seriously. I am a weepy, bitchy mess when I am taking them so I also kicked those. I have had pretty lousy side effects from EVERY medication I have taken for it so I have opted to forgo medications at this time. I am treating it 100% naturally - through diet and exercise. I am not a doctor so I cannot advise you to do the same but I can say that following a low carb diet has improved my symptoms FAR more drastically then any of the medications ever did.
PCOS is the leading cause of infertility in the United States. I think PCOS infertility can be reversed by adapting a low carb lifestyle. I know that I went 6 years without getting a natural period (one that was not spurred on by BC pills) and within 5 months of following a low carb diet, my cycles regulated on their own without medication. I can't say if they were ovulatory cycles or not since I was not TTC (and therefore not checking for ovulation) but I feel pretty confident that they were. I had a lot of the common ovulation "symptoms". Of course, as soon as I went off plan, my periods stopped. This happened before I even gained any weight back. This is what has me convinced that it is not only the actual weight loss but also the diet itself that can reverse infertility along with the other pesky symptoms of PCOS. I have included some useful/interesting links below for anyone who wants to learn more about this natural treatment option.
The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome
A Low Carb Diet for PCOS Symptoms
How Does a Low-Carb Diet Help to Reverse PCOS?