Introduction: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder with a range of associated symptoms. No unique therapy is available to restore body homeostasis. The present study aimed to treat PCOS in insulin-resistant infertile women using metformin, inositol, and ECoQ10. Methods: A case-comparative study with 200 PCOS patients divided into four groups (Metformin, inositol, CoQ10, and control diet). Measurements included anthropometrics, hormonal and biochemical tests, and abdominal imaging. Results: Metformin significantly improved BMI, glycemic control, and lipid profiles. Myo-inositol showed the greatest improvement in HOMA-IR and fasting blood sugar. CoQ10 had modest effects on BMI but significantly decreased fasting blood sugar and HOMA-IR. Metformin and myo-inositol also improved fertility hormones and lipid profiles. Conclusion: Metformin and myo-inositol effectively improve metabolic and hormonal parameters in PCOS, while CoQ10 enhances metabolic markers. Individualized treatment plans and further research into long-term efficacy are recommended.