A 25 year-old woman presents to the clinic with complaints of infertility. She describes having irregular periods her entire life. Physical exam is significant for hormonal cystic-appearing acne along the jaw line and male-pattern facial hair. Lab results are positive for elevated levels of testosterone and the development of pre-diabetes. Ultrasound of the ovaries demonstrate no abnormalities. What is the most likely diagnosis? Describe the underlying pathophysiology of this disease process in detail. Note that you must get the diagnosis correct to receive credit on this question.