Reproductive Outcomes After <i>In Vitro</i> Fertilisation Amongst Different Phenotypes of PCOS

Objectives: To study reproductive outcomes in different polycystic ovary syndrome (PCOS) phenotypes after in vitro fertilisation (IVF) treatments. Material and Methods: It is a prospective observational study, conducted from October 2024 to April 2025 at the Centre of IVF and Human Reproduction, Sir Ganga Ram Hospital, New Delhi. Women undergoing IVF were screened for the presence of PCOS and diagnosed based on Rotterdam’s criteria. These women were then subcategorised into the four PCOS phenotypes based on their presenting features. All women with PCOS who were scheduled for assisted reproductive technologies (ART) procedures during the study period and met the inclusion criteria were enrolled in the study. Metabolic disorders were screened with lipid profiles, mean blood glucose levels, and free androgen index. Primary outcomes studied were the β hCG positive rate, implantation rate per transfer, clinical pregnancy rates after the first transfer, and early pregnancy loss rate. Secondary outcomes studied were total dose of gonadotropins used, days of stimulation, number of oocytes retrieved, number of oocytes fertilised, number of cleaved embryos, fertilisation rate, median utilisable blastocyst number per patient, blastulation rate, and utilisable blastocyst rate. Results: There were 10 (18.9%) patients with phenotype A, 6 patients in phenotype B (11.3%), 15 in phenotype C (28.3%), and 22 in phenotype D (41.5%). The most prevalent phenotype was D (41.5%). Women with phenotype A though, had higher serum AMH levels ( p -value = 0.006), and had a higher median utilisable blastocyst number per patient ( p value = 0.024), but the β-hCG positive rate, implantation rates after first embryo transfer, clinical pregnancy rate, and early pregnancy loss rate were similar in the patients with different phenotypes of PCOS. There was no statistical difference in the total dose of gonadotropins used, number of oocytes retrieved, oocytes fertilised, cleaved embryos, fertilisation rate, blastulation rate, and utilisable blastocyst rate. Metabolic disorder screening results indicated higher cholesterol levels in patients with Phenotype B ( p value = 0.01), although no difference was noted in levels of HDL, LDL, non-HDL, triglycerides, and mean glucose levels in the patients with different phenotypes of PCOS. Conclusion: Our study results suggest that reproductive outcomes, including β hCG positive rate, implantation rate per embryo transfer, clinical pregnancy rate after first embryo transfer, and early pregnancy loss rates, were similar amongst patients with different phenotypes of PCOS. Patients with phenotype A had higher serum AMH levels and had a higher median utilisable blastocyst number per patient, but the utilisable blastocyst rate was comparable across all the phenotypes of PCOS. The study is underpowered to detect differences in reproductive outcomes due to the smaller number of patients enrolled in the study.