Polycystic ovary syndrome (PCOS) is multifaceted with implications extending beyond reproduction. The interplay between PCOS and long-term health consequences, such as metabolic syndrome, highlights the importance of identification, management, and treatment of this condition. Understanding the prevalence, phenotype, metabolic, and psychological impacts of PCOS across different racial and ethnic populations is important for individualized patient care. In this chapter, we review differences in prevalence, symptomatology, and metabolic disorders in women with PCOS across racial and ethnic groups and the impact that race and ethnicity may have on access to fertility treatments.