OBJECTIVE:

To evaluate the influence of polycystic ovary syndrome (PCOS) phenotypes on ovarian response, reproductive outcomes, and perinatal outcomes.

MATERIALS AND METHODS:

This was an observational, retrospective study of cycles in patients with polycystic ovary syndrome from January 2021 to December 2024. Patients were classified according to phenotypes A-D (anovulation, clinical-biochemical hyperandrogenism, and polycystic morphology). Kruskal-Wallis, chi-square, and multiple logistic regression tests were applied (p < 0.05).

RESULTS:

A total of 181 cycles from 149 patients were studied. Phenotype A (46.4%) had the highest BMI (p = 0.004) and the highest follicular count (32 follicles; p = 0.001). Phenotype B exhibited the highest anti-Müllerian hormone concentrations (p < 0.002) and the highest fertilization rate (85.3%; p = 0.012). There were no significant differences in clinical pregnancies or live births between phenotypes. Logistic regression identified high BMI as an independent negative predictor of live birth (OR: 0.37; p = 0.028) and a modulator that varies by phenotype.

CONCLUSION:

Polycystic ovary syndrome phenotypic stratification reveals distinct clinical, metabolic, and reproductive profiles. Although phenotype A shows greater ovarian reserve, perinatal success mainly depends on metabolic factors (BMI and anti-Müllerian hormone).

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