Background: Polycystic ovary syndrome(PCOS) is commonly associated with obesity and infertility worldwide. A significant subset of women exhibit the lean PCOS phenotype including the Asian populations but the reproductive impact of lean PCOS in Indian women 

remains under-explored. 

Objective: To systematically review and synthesize available Indian evidence evaluating the association between lean PCOS and infertility.

Methods: A systematic search of PubMed, Google Scholar, Scopus, and Indian medical journals was conducted for studies published up to 2024 involving Indian women with PCOS that reported infertility or reproductive outcomes. Participants were stratified by BMI. Lean PCOS was defined using Asian BMI criteria (<23 kg/m²). Data were extracted on infertility prevalence, ovulatory dysfunction, and treatment outcomes. A qualitative meta-analytic synthesis was performed.Results: Ten studies met inclusion criteria, comprising cross-sectional, observational, and interventional designs. Lean PCOS constituted approximately 25–35% of infertile PCOS cases in Indian cohorts. Infertility prevalence and ovulatory dysfunction were comparable between lean and obese PCOS groups. Lean PCOS women demonstrated preserved metabolic profiles but persistent endocrine abnormalities leading to anovulation. Ovulation induction and ART outcomes were comparable or superior in lean PCOS compared to obese PCOS.

Conclusion: Lean PCOS is a clinically significant contributor to infertility in Indian women. Despite normal BMI, these women experience substantial ovulatory dysfunction and infertility. Recognition of lean PCOS as a distinct but equally impactful phenotype is essential for timely  diagnosis and management. 

Rachamalla Chaitra finished her M.B.B.S and M.S. Obstertics and Gynaecology from Dr.N.T.R University of health sciences, India standing University 2nd and is currently pursuing fellowship in reproductive medicine from Cloudnine hospitals, India. She finished advanced diploma in ART and reproductive medicine, hosted by Johns Hopkins university and Antenatal and Postnatal rehabilitation (A.P.P.R) certification from Physioneeds academy, London, U.K. She has international publications under her name and was also awarded with Best review of literature award in research induction workshop conducted by Research advancing scholars consortium in 2024. She presented numerous oral posters and papers in various conferences.