The association between insulin resistance and unexplained recurrent miscarriage

Abstract

Conventionally, the recurrent pregnancy loss was defined as three consecutive losses earlier than 20 weeks of gestation, but testing the women after 2 losses could spare them of another pregnancy failure; thus the definition was modified lowering the number of spontaneous losses to two. Recurrent pregnancy loss affects 2%–4% of reproductive-age couples, representing a challenge for the physicians, affecting both naturally conceived pregnancies and those obtained after assisted reproductive technology treatment, In the etiology of RPL a broad spectrum of factors has been described: chromosome anomalies, uterine malformations or anomalies, immunological factors, hypothyroidism, cervical incompetence, antiphospholipid syndrome, bacterial infections, and polycystic ovary syndrome (PCOS) but half of the cases remain unexplained. Insulin resistance and hyperinsulinemia are claimed to be a potential cause of the high rate of pregnancy loss in patients with PCOS and have been linked to the metabolic and endocrine abnormalities associated with the pathophysiology of recurrent pregnancy loss. Using the fasting blood glucose, fasting insulin, and HOMA (homeostasis model assessment) score, the insulin resistance was found three times higher in an unselected population of women with recurrent pregnancy loss when compared with normal population