Many patients have told me that they have irregular menstruation, and that it takes herbs or progesterone to get a period. In some cases, the embryos stopped developing before they reached two months of age, which is really sad! For these patients, I deeply understand their feelings and would like to provide them with a little help. In the above mentioned cases, the most suspected disease is polycystic ovary syndrome (PCOS), a common reproductive endocrine and metabolic disorder in women of reproductive age, characterized by sparse menstruation, increased androgens, hirsutism, infertility, and obesity. Some people with milder disease have roughly normal menstruation, but are prone to miscarriage. Some people with irregular menstruation can conceive after menstrual regulation by Chinese herbs or western medicine or ovulation treatment, but miscarriage is easily caused due to luteal insufficiency. In addition to luteal insufficiency, miscarriage may also be caused by insulin resistance, coagulation and fibrinolytic dysfunction and immunosuppressive glycoprotein deficiency, resulting in embryonic abortion. In recent years, with the introduction of assisted reproductive technology, the conception rate of PCOS patients has increased, but their chances of miscarriage and gestational diabetes after conception are much higher than those of the normal population, and they are prone to adverse pregnancy outcomes if not monitored carefully. The mechanism of miscarriage in patients with polycystic ovary syndrome is complex and not well understood, and may be due to the following reasons: 1. imbalance of progesterone and estrogen ratio, relative deficiency of progesterone, abnormal regulation of estrogen receptors and progesterone receptors in the endometrium, so that endometrial development is not synchronized with embryonic development, resulting in miscarriage due to failure of fertilized egg implantation; 2. 2. Patients with PCOS often have insulin resistance and elevated androgen levels, which can delay the expression or non-expression of αβ integrins, resulting in endometrial dysplasia leading to obstruction of fertilized egg implantation. 3. Decreased endometrial tolerance, commonly known as the uterus is unprepared for the arrival of the embryo. Glycodelin can inhibit the immune response of the endometrium to the embryo and facilitate the implantation of the fertilized egg; a decrease in Glycodelin makes the embryo vulnerable to the maternal immune system, thus increasing the chance of miscarriage. 4. Increased levels of plasma fibrinogen activator inhibitor (PAI-1) during early pregnancy in patients with PCOS can induce chorionic villi thrombosis, resulting in poor trophoblast development and miscarriage. A large number of studies have shown that insulin resistance is the pathophysiological basis of polycystic ovary syndrome. Due to the presence of insulin resistance, the body’s need for insulin increases, and gestational diabetes can occur if the islets are potentially deficient, and patients with gestational diabetes are prone to miscarriage, preterm delivery, fetal malformations, and other adverse pregnancy outcomes. What can be done to prevent recurrence of embryonic abortion and adverse pregnancy outcomes? First of all, we should do some relevant tests before pregnancy, such as blood endocrine 6 tests (preferably on the 20th to 23rd day of menstrual cycle to understand luteal function), glucose tolerance and insulin release test to understand the function of pancreatic B cells and whether there is insulin resistance; vaginal ultrasound to observe whether there are polycystic ovaries (note that you should remind your doctor or find an experienced doctor to check, otherwise it may cause missed diagnosis). If necessary, immune function tests such as Glycodelin and coagulation and fibrinolytic tests such as PAI-1 should be done. When pregnant again, close monitoring and anti-fetal treatment should be carried out, including regular HCG and progesterone measurements and ultrasound; luteinizing support treatment; diet control and glucose lowering treatment if gestational diabetes is present; coagulation and fibrinolytic tests such as PAI-1 abnormalities For those with elevated coagulation and fibrinolytic function, treatment with microcirculatory drugs such as low molecular heparin can be used; for those with hyperinsulinemia but not hyperglycemia, many foreign studies have reported that the application of insulin sensitizer metformin treatment can reduce the incidence of miscarriage without causing significant side effects, and no fetal malformation or dysplasia was found. There are no reports in the domestic literature on these aspects, although studies have been conducted in this area. In conclusion, although patients with PCOS have an increased chance of miscarriage and diabetes during pregnancy, the treatment will become more effective as research into its pathogenesis continues.