**Core Concept**
Polycystic ovarian syndrome (PCOS) is a complex endocrine disorder characterized by ovulatory dysfunction, hyperandrogenism, and polycystic ovaries. It is a leading cause of infertility in women and is often associated with insulin resistance, metabolic syndrome, and increased risk of cardiovascular disease.

**Why the Correct Answer is Right**
PCOS is classically associated with insulin resistance, hyperinsulinemia, and metabolic syndrome, which contribute to the development of hyperandrogenism and ovulatory dysfunction. The polycystic ovarian morphology on ultrasound is a hallmark of PCOS, but it is not a diagnostic criterion. The syndrome is also associated with an increased risk of gestational diabetes, type 2 diabetes, and cardiovascular disease.

**Why Each Wrong Option is Incorrect**
**Option A:** Insulin resistance is a key feature of PCOS, and it contributes to the development of hyperandrogenism and ovulatory dysfunction. Therefore, this option is incorrect because it is actually associated with PCOS.
**Option B:** Hyperandrogenism is a classic feature of PCOS, and it is often manifested as hirsutism, acne, and male pattern baldness. This option is incorrect because it is indeed associated with PCOS.
**Option C:** Polycystic ovaries on ultrasound are a common finding in women with PCOS, but they are not a diagnostic criterion. This option is incorrect because it is indeed associated with PCOS.

**Clinical Pearl / High-Yield Fact**
PCOS is often associated with insulin resistance, which can be assessed using the homeostatic model assessment (HOMA) or the fasting insulin-to-glucose ratio. Early diagnosis and treatment of PCOS can help prevent long-term complications such as type 2 diabetes and cardiovascular disease.

**Correct Answer:** D