Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting reproductive health. It is characterized by irregular menstrual cycles, hirsutism, infertility, and metabolic disturbances. This study aims to assess the impact of PCOS on reproductive and metabolic health compared to healthy controls. Methods: This cross-sectional comparative study was conducted at BSMMU, Dhaka, from 2014 to 2015 (one year). Data on demographic characteristics, clinical outcomes, hormonal and metabolic parameters, and reproductive health indicators were collected. Hormonal profiles included LH/FSH ratio, serum testosterone, serum insulin, fasting glucose, and HOMA-IR. Reproductive health indicators assessed included anovulation, endometrial thickness, ovulation induction success, and time to pregnancy. Treatment outcomes for PCOS-related infertility were also analyzed. Results: The PCOS group exhibited significantly higher rates of irregular menstrual cycles (77.8% vs. 12.5%), hirsutism (66.7% vs. 12.5%), infertility (62.2% vs. 25.0%), insulin resistance (44.4% vs. 12.5%), and obesity (22.2% vs. 12.5%) compared to the control group. Hormonal parameters revealed elevated LH/FSH ratios, serum testosterone, and insulin levels, along with higher fasting glucose and HOMA-IR in the PCOS group. Reproductive health indicators showed greater anovulation, thicker endometrial lining, reduced ovulation induction success, and longer time to pregnancy in the PCOS group. Treatment outcomes varied, with gonadotropins demonstrating the highest response rate (80%). Conclusion: PCOS significantly impacts reproductive health and metabolic parameters. Personalized treatment approaches, emphasizing lifestyle modification and targeted therapies, are crucial for managing PCOS effectively.