Polycystic ovary syndrome (PCOS) is a complex pathology caused by endocrine abnormalities commonly seen in women of reproductive age, with the main pathological features being hyperandrogenism, or insulin resistance/hyperinsulinemia. In addition to common chromosomal abnormalities, anatomical abnormalities, infections, and immune factors, the causes of miscarriage in PCOS patients may be related to endocrine disorders such as hyperluteinizing (LH), hyperandrogenism, and hyperinsulinemia. Hyper-LH may cause premature follicular maturation, which affects oocyte and embryo quality leading to early miscarriage. Hyperandrogenemia may be the result of a direct effect on the oocyte. It is also possible that excess androgens antagonize estrogen, which can affect endometrial proliferation and luteal phase endometrial secretion, thus affecting embryo implantation and leading to miscarriage. Insulin resistance/hyperinsulinemia is currently recognized as the basic pathological feature of PCOS, and high insulin levels can increase androgen levels, thus affecting conception and embryo implantation in PCOS patients.