Polycystic ovary syndrome (PCOS),
thrombophilia, and hypofibrinolysis are associated with recurrent pregnancy loss (RPL) and
spontaneous abortion (SAB). In 28 Caucasian women, 21 women with PCOS (4 with previous
thrombosis, 18 with 1 SAB or more, and 20 with 1 coagulation disorder or more), and 7 women with coagulation disorders-thrombi, we speculated that prospective treatment with
enoxaparin-
metformin or
enoxaparin alone would successfully and safely promote healthy live births compared with previous untreated pregnancies. In 21 women with PCOS,
metformin (1.5-2.55 g/day) was given before and during pregnancy with concurrent
enoxaparin (60 mg/day). Of 21 PCOS women, 19 women had 40 previous untreated pregnancies, 7 had live births (18%), 3 had elective abortions (ABs) (8%), and 30 had SABs (75%). On
enoxaparin-
metformin, these 19 women had 24 pregnancies, 20 live births (83%), and 4 SABs (17%); the SAB rate was 4.4-fold lower than previous untreated pregnancies (McNemar's s = 20.8, P < 0. 0001). Two women with PCOS without previous pregnancies, but with previous
thrombosis, had 2 pregnancies on
enoxaparin-
metformin and 2 live births. Of the 7 women with coagulation disorders-thrombi, 4 had 15 previous pregnancies without
enoxaparin, with 6 live births (40%), 8 SABs (53%), and 1 elective AB (7%). On
enoxaparin, these 4 women had 4 pregnancies, with 4 (100%) live births (McNemar's s = 8.0, P = 0.005). The other 3 women with coagulation disorders-thrombi had 4 pregnancies on
enoxaparin with 4 live births. No adverse maternal-fetal side effects were reported on
enoxaparin alone or
enoxaparin-
metformin.
Enoxaparin-
metformin reduces pregnancy loss in women with PCOS-coagulation disorders and in women with coagulation disorders-thrombi.