PCOS Phenotypes Show Similar ART Pregnancy Outcomes, Study Finds

Women with polycystic ovary syndrome (PCOS) who undergo assisted reproductive technology (ART) appear to have broadly similar clinical pregnancy rates, live birth rates and neonatal outcomes regardless of which PCOS phenotype they have, according to a retrospective study published in the European Journal of Medical Research. The findings, released as an early-access, peer-reviewed accepted article, also point to a possible phenotype-specific pattern in certain obstetric complications, although the researchers urge caution because of the limited number of events observed.

The study, led by Tingting Cheng and colleagues, analysed 1,377 PCOS patients treated between January 2018 and July 2023. Using the Rotterdam criteria, the team stratified patients into four phenotypic groups: phenotype A (oligo-anovulation plus hyperandrogenism plus polycystic ovarian morphology), phenotype B (oligo-anovulation plus hyperandrogenism), phenotype C (hyperandrogenism plus polycystic ovarian morphology, the ovulatory phenotype), and phenotype D (oligo-anovulation plus polycystic ovarian morphology, the non-hyperandrogenic phenotype). The groups comprised 473, 72, 168 and 664 patients respectively.

The four phenotypes were comparable in maternal age, baseline follicle-stimulating hormone and oocyte yield, but differed significantly in duration of infertility, body mass index, baseline luteinising hormone, testosterone and anti-Müllerian hormone levels.

When the researchers examined pregnancy outcomes, they found no significant interphenotype differences in implantation rate, clinical pregnancy rate, miscarriage rate, live birth rate or singleton birth weight. This suggests that, at least in this cohort, the phenotypic variation that shapes the hormonal presentation of PCOS did not translate into measurable differences in the core measures of ART success.

The picture was more nuanced for obstetric complications. Significant interphenotype differences were observed in the incidences of gestational hypertension, placenta-related complications and other complications. However, after multivariable adjustment, PCOS phenotype was not independently associated with gestational hypertension or placenta-related complications. PCOS phenotypes were identified as significant contributors to other complications, but the authors emphasise that the limited number of events warrants cautious interpretation of this result.

In twin pregnancies, fetal weight and length differed significantly across phenotypes in the initial analysis. After multivariable adjustment, however, PCOS phenotype was no longer significantly associated with these outcomes, indicating that other factors accounted for the apparent differences.

The authors conclude that among PCOS patients undergoing ART, clinical pregnancy rates, live birth rates and neonatal outcomes appear broadly comparable across phenotypes, while the risk profiles for obstetric complications suggest a possible phenotype-specific pattern that should be interpreted with caution given the sample size. They call for further prospective studies to clarify these phenotype-specific risk profiles and to explore their implications for antenatal management.

The study’s retrospective design and single-cohort structure are important limitations, and the authors note that the relationship between phenotypic heterogeneity in PCOS and pregnancy and neonatal outcomes in women undergoing ART remains insufficiently explored across phenotypes. Because the article is being shared early to provide faster access to peer-reviewed, accepted research, it is citable and carries a permanent DOI, but this version is subject to further edits and will be replaced by the final Version of Record.

Subject of Research: Phenotypic heterogeneity in PCOS and pregnancy outcomes in patients undergoing assisted reproductive technology

Article Title: Phenotypic heterogeneity and adverse pregnancy outcomes in polycystic ovary syndrome patients undergoing ART: exploring potential links for prenatal surveillance

Article References: Cheng, T., Bu, Z., Luo, X., Zhao, C., Zhou, S., & Jin, H. (2026). Phenotypic heterogeneity and adverse pregnancy outcomes in polycystic ovary syndrome patients undergoing ART: exploring potential links for prenatal surveillance. European Journal of Medical Research. https://doi.org/10.1186/s40001-026-05346-0

Image Credits: AI Generated

DOI: 10.1186/s40001-026-05346-0

Keywords: PCOS, assisted reproductive technology, Rotterdam criteria, phenotypes, gestational hypertension, placenta-related complications, live birth rate, retrospective study, antenatal monitoring, twin pregnancies, hyperandrogenism, obstetric complications