Abstract
Polycystic Ovary Syndrome (PCOS) is a heterogeneous endocrine–metabolic disorder and one of the leading causes of anovulatory infertility. Although women with PCOS are often managed as a relatively homogeneous population during assisted reproductive treatment, the four Rotterdam phenotypes differ substantially in endocrine function, metabolic profile, ovarian reserve, follicular microenvironment, ovarian responsiveness, and reproductive potential. These biological differences may contribute to the considerable variability observed in In Vitro Fertilization (IVF) outcomes and treatment-related complications. This review examines the clinical significance of PCOS phenotypes in assisted reproduction by integrating current evidence on endocrine and metabolic heterogeneity, ovarian response to stimulation, oocyte competence, embryo development, implantation, cumulative live birth rates, and pregnancy-related outcomes. Overall, hyperandrogenic phenotypes demonstrate greater ovarian responsiveness and a higher risk of Ovarian Hyperstimulation Syndrome (OHSS), whereas non-hyperandrogenic phenotypes are generally associated with more favorable reproductive outcomes. These findings suggest that phenotypic classification provides clinically meaningful information beyond conventional predictors such as age, ovarian reserve markers, body mass index, and previous treatment response. Incorporating phenotype-specific characteristics into IVF planning may improve risk stratification, protocol selection, OHSS prevention, and patient counseling. Future integration of phenotype-based classification with emerging molecular biomarkers and artificial intelligence–assisted predictive models may further advance precision reproductive medicine. Overall, PCOS phenotypes should be regarded not merely as diagnostic categories but as clinically relevant indicators of reproductive behavior that can support safer, more individualized, and more effective IVF management.
Keywords
Polycystic ovary syndrome, PCOS phenotypes, In vitro fertilization, Phenotype-guided IVF, Personalized reproductive medicine