OBJECTIVE: To investigate how serum uric acid (SUA) influences the reproductive outcomes among women with polycystic ovary syndrome (PCOS) undergoing freeze-all strategy. DESIGN: Retrospective cohort study. Setting: Reproductive center in a tertiary hospital in China. Population: 1115 women aged 20-40 years with PCOS were included. Method: The entire population was categorized into four groups based on SUA quartiles, logistic regression analysis was conducted to determine odds ratios (ORs) for reproductive and pregnancy complications, adjusting for potential confounders. Main Outcome Measures: Primary outcome was live birth, defined as the gestational age ≥28 weeks or weighing ≥ 1000 grams. RESULTS: In quartiles of SUA levels, there was no significant difference in the live birth rate from the lowest quartile (Q1: 57.9%) to the highest (Q4: 56.6%) (adjusted OR 1.08, 95% CI, 0.74-1.57, P=0.58). Similarly, SUA showed no significant effect on biochemical and clinical pregnancy rate, or miscarriage rate (p>0.05). Women in quartile 4 had added the risk of gestational diabetes mellitus (GDM) (adjusted OR 3.87, 95% CI 1.77-8.47), gestational hypertension (GH) (adjusted OR 3.82, 95% CI 1.16-12.58) compared with quartile 1. Women in quartile 4 also had an increased probability of preterm birth and low birth weight（adjusted OR 2.24, 95% CI 0.90-5.59；adjusted OR 3.58, 95% CI 0.88-14.56, respectively). CONCLUSION: No significant correlation was found between SUA and live birth in women with PCOS undergoing freeze-all strategy. However, elevated SUA increased the risk of GH, GDM and tended to increase the risk of preterm labor and LBWI.