**9. Metformin treatment**

*Induced Abortion and Spontaneous Early Pregnancy Loss - Focus on Management*

reason and not PCOS as a whole [60–68]. The incidence of abortions in spontaneous ovulation is difficult to determine. Diagnostic criteria for this heterogeneous disorder have not been present in the past. Hypersecretion of LH and elevate androgen levels possibly led to RPL [60–68]. The association of excess androgens and RPL is not clear. The hyperinsulinemia in PCOS that is a consequence of insulin resistance involving plasminogen activator inhibitor-1(PAI-1) which inhibits plasminogen activation and subsequent fibrinolysis, has potential thromboembolic effect that makes women with PCOS in high risk for recurrent pregnancy

**68**

loss [60–68].

**8.9 Why LH rise may result in abortion**

• hyperandrogenemia may impact on oocytes

• in vitro studies show inhibitory effect of androstenedione

• gene hoxa10 is thought to be essential for implantation.

Preimplantation environment is affected by decreasing:

• in endometrial cell growth and activity (glycodelin secretion)

• glycodelin inhibits endometrial immune response to the embryo [60–68]

• the expression of this gene is decreased when testosterone is elevated.

1. expression of glycodelin—which inhibits endometrial immune response to the

Plasminogen activator inhibitor gene (PAI-1) activity (i.e., hypofibrinolysis) is

Metformin reduces gene activity from 42.5 to 12.4 U/ml, that is, correct tendency

2.IGF—binding protein-1, which facilitates adhesion progress at the fetomaternal interface. Plasma plasminogen activator inhibitor-1 concentrations are increased in hyperinsulinemia leading to hypofibrinolytic state and

• high androgens may affect endometrium

• androgens may affect endometrium

• premature oocyte maturation

**8.10 Role of androgen abortion**

**8.12 Hyperinsulinemia: abortion**

thrombophilia [60–68]

**8.13 PCO—abortion: thrombophilia**

for thrombosis which improves uteroplacental flow.

**8.11 Endometrium**

embryo and

elevated in PCO.

PAI-1 activity fell 44% in women with live births. PAI-1 activity increased 19% in women with abortion.
