Hello dear Under stand your concern Pathophysiology of miscarriage is remain unclear. There is multiple hypothesis for that. Main reason is the insulin resistance and hyperinsulinemia. Other mechanism are as follows that are also directly linked with hyperinsulinemia. Abnormal development of endometrium during implantation, obesity, increased activity of plasminogen inhibitor and protein C resistance lead to vascular uteroplacental insufficiency, abnormal gonadotropin hormone secretion, increased uterine vascular Resistance. So main aim is to reduce insulin resistance:Start exercise, maintain weight, and continue on metformin, inositol, clomiphane and aspirin. Once you become pregnant: gynecologist may provide: gonadotropin hormone, ovulation induction medicine, HCG and progesterone to support pregnancy. Laproscopy may be helpful in some case of PCOS. Avoid constipation and stress. Hope this may help you Best regards Dr. Sagar