Polycystic ovary syndrome and miscarriage: a narrative review

ESSENTIAL POINTS1)The multifaceted nature of PCOS, including the high prevalence of overweight/obesity and overlapping features (e.g. insulin resistance and hyperandrogenism), complicates examining its independent and direct impact and may potentially account for the contradictory findings regarding miscarriage risk in this population.2)Some studies have suggested an independent link between PCOS and miscarriage/RPL, highlighting PCOS-related effects on oocyte/embryo quality, endometrial receptivity, and the uterine environment.3)While studies have explored PCOS-specific risk-mitigating interventions such as use of metformin, vitamin D, and antioxidants, the data remains limited and inconclusive, necessitating further research to unravel PCOS's overlapping influences on miscarriage/RPL and develop targeted interventions to mitigate poor reproductive outcomes.ABSTRACTPolycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age. Although women with PCOS are often identified when presenting for oligomenorrhea or infertility care, PCOS is also linked to several metabolic morbidities, which may predispose to poor reproductive outcomes. Research has also suggested a possible independent association between PCOS and miscarriage, although available data are conflicting. This review focuses on the current literature regarding the risk of miscarriage and recurrent pregnancy loss (RPL) in women with PCOS. First, we give an overview of the prevalence of miscarriage and RPL in this population and identify study limitations that contribute to the conflicting data regarding the potential association. Subsequently, we review the current literature on obesity, insulin resistance and hyperinsulinemia, thrombophilia, hyperandrogenism, oocyte, and embryo quality and viability, endometrial receptivity, oxidative stress and chronic inflammation, in addition to the efficacy of potential risk-mitigating interventions for miscarriage in women with PCOS.