Objective To compare the outcome of unstimulated in vitro maturation (IVM) and routine IVF/intracytoplasmic sperm injection (ICSI) for women with polycystic ovaries (PCO). Design Retrospective case–control study. Setting Fertility unit. Patient(s) Ninety-seven patients undergoing IVM were compared with 97 patients undergoing IVF. All had PCO and matched for age, infertility diagnosis, and ovulatory status. Intervention(s) In vitro maturation cycles were unstimulated and hCG was administered 35–40 hours before oocyte retrieval. Oocytes were matured in vitro for 24–48 hours before insemination by ICSI. Endometrial priming with E2 and P was commenced from the day of egg retrieval and one to two embryos were transferred on days 2–5 of development. Standard long protocol IVF/ICSI was used in the control group. Main Outcome Measure(s) Live birth rate per cycle and ovarian hyperstimulation syndrome (OHSS) rate. Result(s) Overall, 65% of IVM eggs matured in vitro in the IVM group. Implantation rates were significantly higher in the IVF group (19.4% vs. 12.9%) as clinical pregnancy rates (50.5% vs. 19.6%) and live birth rates (44.3% vs. 16.5%) than in the IVM group. The OHSS rate was significantly higher in the IVF group (8.2% vs. 0%). Conclusion(s) In vitro maturation is a safer and simpler alternative to conventional IVF for women with PCO. It avoids difficulties of gonadotropin stimulation and the risk of OHSS but has a significantly lower live birth rate. Current research projects aim to close the success gap between IVM and IVF.