The Impact of Polycystic Ovary Syndrome on Tubal Ectopic Pregnancy Risk During First Pregnancy

Aim: This study aimed to investigate the effect of Polycystic Ovary Syndrome (PCOS) on the risk of tubal ectopic pregnancy during first pregnancy and how this risk varies across different PCOS phenotypes. Materials and Methods: This retrospective study analyzed 657 women diagnosed with ectopic pregnancy between November 2022 and November 2024 at a tertiary care hospital. Of these, 222 women had confirmed tubal ectopic pregnancies and a documented diagnosis of PCOS at the same center. The participants were divided into two groups based on the Rotterdam criteria: PCOS (n=76) and non-PCOS (n=146). PCOS phenotypes were further classified as Phenotype A (hyperandrogenism, oligo-/anovulation, and PCOM), Phenotype B (hyperandrogenism and oligo-/anovulation), Phenotype C (hyperandrogenism and PCOM), and Phenotype D (oligo-/anovulation and PCOM). Results: Women with PCOS had a significantly higher incidence of tubal ectopic pregnancy during their first pregnancy compared to non-PCOS women (OR: 4.42, 95% CI: 2.22–8.80, p < 0.001). Among PCOS phenotypes, Phenotype C (hyperandrogenism and polycystic ovarian morphology) was the most common (32.9%), followed by Phenotype D (23.7%). Non-PCOS women exhibited higher rates of conventional risk factors, such as intrauterine device use, pelvic inflammatory disease (PID), and previous pelvic surgeries. Conclusion: PCOS may be associated with an increased risk of tubal ectopic pregnancy, especially during the first pregnancy. The findings suggest that hormonal and structural disruptions in PCOS, may impair fallopian tube function and embryo transport. These results underscore the need for targeted fertility counseling and management strategies in women with PCOS to mitigate ectopic pregnancy risks.