A prospective cohort study evaluated the effect of Xiaonang Yusi decoction (XNYSD) on IVF-ET outcomes in 32 wet mucus PCOS patients compared to a control group (n=32). Traditional Chinese medicine treatment significantly improved mucus dampness symptoms, embryo implantation rate (67.9% vs. 29.0%), clinical pregnancy rate (52.2% vs. 28%), and continued pregnancy rate (60.7% vs. 29.0%), all p < 0.05, with no difference in early miscarriage (p > 0.05). Follicular fluid metabolomics showed increased levels of four arachidonic acid metabolites, including 15(S)-HETE, in PCOS patients versus controls (p < 0.05), which were significantly reduced by treatment (p < 0.05). Network pharmacology demonstrated that the decoction modulates 15(S)-HETE-mediated pathways through targets such as ESR1 and SIRT1, including lipid metabolism and PI3K-Akt signaling. Molecular docking confirmed favorable interactions of active ingredients with key targets. The decoction thus improves the symptoms of TCM syndrome, the quality of the embryos and the pregnancy rate in these patients.[1]