Treatment of Hyperandrogenism Versus Insulin Resistance in Infertile Polycystic Ovary Syndrome (PCOS) Women

Couples Inclusion Criteria: * Partner with sperm concentration of \>=14 million/mL in at least one ejaculate with motile sperm. * Ability to have regular intercourse 2-3 times per week during the ovulation induction phase of study. * At least one patent tube and normal uterine cavity as determined by sonohysterogram, hysterosalpingogram, or hysteroscopy/laparoscopy within the last 3 years, or confirmation of a intrauterine pregnancy within the past 2 years. * No previous sterilization procedures(vasectomy, tubal ligation) that have been reversed. * Wanting to seek pregnancy. Inclusion Criteria: * Chronic anovulation or oligomenorrhea defined as intermenstrual periods of \>= 45 days or a total of \<=8 periods per year. * Hyperandrogenism will be an elevated total testosterone \>=50 ng/dL. * Hirsutism determined by a modified Ferriman-Gallwey Score \>8. * PCO on ultrasound (12 or more follicles measuring 2-9 mm in diameter). * BMI \>=27 to \<=42. * Normal EKG to rule out any abnormalities with the heart. Exclusion Criteria: * Current pregnancy. * Patients on oral contraceptives, depo progestins, or hormonal implants. * Patients with hyperprolactinemia defined as two prolactin levels at least one week apart \>30 ng/mL. * Patients with known 21-hydroxylase deficiency by a fasting 17-hydroxyprogesterone (17-OHP) level \<2 ng/mL and ACTH stimulation test as needed, or other enzyme deficiency. * Patients with menopausal FSH levels \>20 mIU/mL. * Patients with uncorrected thyroid disease (TSH \<0.45 mIU/ML or \>4.5 mIU/ML). * Patients diagnosed with Type1 or Type II diabetes. * Patients with liver disease defined as AST or ALT \>2 times normal or total bilirubin \>2.5 mg/dL. * Patients with renal disease defined as BUN \>30 mg/dL or serum creatinine \>1.4 mg/dL. * Patients with significant anemia (Hemoglobin \<10 mg/dL). * Patients with a history of deep venous thrombosis, pulmonary embolus, or cerebrovascular accident. * Patients with known heart disease that is likely to be exacerbated by pregnancy. * Patients with a history of , or suspected cervical carcinoma, endometrial carcinoma, or breast carcinoma. A normal PAP smear or reassuring colposcopy based on current ACOG guidelines will be required. * Patient with current history of alcohol abuse. * Patients enrolled simultaneously into other investigative studies. * Patients taking other medications know to affect reproductive function or metabolism. * Patients with a suspected adrenal or ovarian tumor secreting androgens. * Patients with suspected Cushing's syndrome. * Patients who have undergone a bariatric surgery procedure in the recent past (\<12 months). * Patients with untreated poorly controlled hypertension defined as systolic blood pressure \>=150 mm Hg or average diastolic \>=100 mm Hg on three measurements obtained 5 minutes apart. If treated, average systolic blood pressure \>= 140 mm Hg or average diastolic \>= 90 mm Hg. * Patients with medical conditions that represent contraindications to orlistat, OCP, clomiphene, and/or pregnancy. * Patients currently participating in lifestyle intervention program (Weight Watchers, Atkins Diet, Curves) or lost more than 5% body weight within the last 6 months.