Objectives : The study targets to evaluate the outcomes of polycystic ovarian syndrome (PCOS) infertile women undergoing intracytoplasmic sperm injection (ICSI) using single (SBT) versus double blastocyst transfer (DBT) strategy.   
Patients & Methods : 271 infertile PCOS women diagnosed according to the Rotterdam criteria, aged 20-35 years, had body mass index (BMI) of <35 kg/m2 and mild hyperandrogenemia were randomly categorized into SBT and DBT groups and underwent elective frozen-thawed autologous day-5 good-quality (5A) BT. Study outcomes included the live birth rate (LBR), and the incidence of pregnancy-related maternal, fetal and neonatal complication.   
Results: Chemical and clinical pregnancy rates were non-significantly higher with DBT. However, the incidence of early pregnancy loss and multiple pregnancy was significantly higher, while the incidence of gestational hypertension and diabetes mellitus, ectopic pregnancy, premature preterm rupture of membrane were non-significantly higher with DBT. On contrary, the incidence of preterm labor (PTL) and the need for cesarean section were significantly higher among women of DBT group. Neonatal outcomes were better with SBT with significantly lower incidence of low birth weight (BW), need for NICU admission and hospital neonatal mortality with significantly higher LBR.  
Conclusion: DBT even of good quality worsens the outcomes of ICSI for PCOS women. DBT is significantly associated with small BW, high incidence of PTL, need for operative delivery and NICU admission with subsequent reduction of LBRs. Also, DBT non-significantly increased the incidence of maternal complications than SBT.