Purpose <p>To examine whether ovarian morphology in polycystic ovary syndrome (PCOS) affects reproductive outcomes in in-vitro-maturation (IVM) cycles.</p> Methods <p>A two-year, single-center retrospective cohort study including PCOS patients undergoing IVM. PCOS diagnosis followed the 2003 Rotterdam criteria, and all subjects had a sonographic criterion (≥ 12 follicles in one ovary). Patients were categorized based on ovarian morphology imaged by trans-vaginal ultrasonography: i)peripheral cystic pattern (PCP), with follicles at the ovarian periphery; ii)general cystic pattern (GCP), with follicles dispersed throughout the ovarian stroma.</p> Results <p>Of 127 subjects, 72 were in the PCP group and 55 in the GCP group. Women with PCP, compared to GCP, had higher rates of hirsutism and oligomenorrhea, and a higher antral follicle count. IVM outcomes showed that women with PCP had significantly more total retrieved oocytes; additional metaphase II oocytes 24- and 48-h post-retrieval;total metaphase II oocytes; IVM metaphase II oocytes; total cleavage stage embryos; and total good-quality embryos. PRs and CPRs were comparable between groups. Multivariable logistic regression adjusting for ovarian morphology type, female age,male age, gravidity, and total testosterone levels, demonstrated that ovarian morphology was not associated with PR or CPR. However, PCP was a predictor for ≥ 10 retrieved oocytes (aOR 12.5, 95%CI 2.44–100,p = 0.003),and ≥ 15 retrieved oocytes (aOR 10, 95%CI 1.75–50,p = 0.009). Additionally, increasing gravidity was associated with a reduced likelihood of ≥ 10 retrieved oocytes (aOR 0.48, 95%CI 0.26–0.91,p = 0.024).</p> Conclusions <p>PCP ovarian morphology in PCOS patients correlated with higher oocyte and mature oocyte yield, cleavage stage embryos,and good-quality cleavage stage embryos, while pregnancy outcomes were comparable.</p>