PCOS and Recurrent Miscarriage: What to Investigate Before Jumping to IVF (and How a Naturopath Can Support You)

PCOS and Recurrent Miscarriage: The Missing Investigation Most Women Never Receive

If you’ve experienced more than one miscarriage, I want to start by saying something clearly:

You are not overreacting. You are not being “too emotional.”And you don’t need to be told to “just keep trying.”

Recurrent miscarriage is devastating, not just physically, but emotionally. It changes the way you view your body, pregnancy, hope, and even your future.

And what frustrates me most is how many women are left in the dark.

They’re told:

• “These things happen.”

• “Miscarriage is common.”

• “At least you can get pregnant.”

• “Just try again.”

Or if you have PCOS:

• “It’s because of your hormones.”

• “It’s just your cycles.”

• “You’ll probably need IVF.”

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And while PCOS can increase miscarriage risk, it’s rarely the full story, especially when losses happen more than once.

Because recurrent miscarriage usually isn’t caused by one big issue. It’s often caused by multiple smaller drivers stacking up: inflammation, insulin resistance, thyroid dysfunction, nutrient depletion, progesterone issues, and yes, sometimes male factor as well.

This is where naturopathic support becomes powerful. Because instead of guessing and hoping, we investigate properly, correct what’s out of balance, strengthen your foundation, and support your body to carry pregnancy more safely.

Photo of an Ultrasound

What Counts as Recurrent Miscarriage?

Recurrent miscarriage (also called recurrent pregnancy loss) is commonly described as:

• two or more miscarriages, especially early losses

Some women are told they “need three” before anyone investigates and personally, I find that heartbreaking.

If you’ve had two losses, you deserve answers. You deserve a plan. And you deserve to feel supported, not dismissed.

PCOS and Miscarriage: Why Risk Can Be Higher

PCOS is not just a fertility condition, it’s a hormonal and metabolic condition.

So when a woman with PCOS experiences miscarriage, I don’t just think:“Let’s make her ovulate.”

I think:

• Is insulin resistance affecting implantation and placental development?

• Is inflammation too high?

• Are nutrients depleted?

• Is thyroid function suboptimal?

• Are progesterone patterns strong enough to support early pregnancy?

• Is there something being missed, like endometriosis or clotting risk?

• Could male factor be contributing?

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Because miscarriage isn’t always about whether you got pregnant, it’s about whether the environment supported pregnancy long enough to continue developing.

The Most Common Drivers Behind PCOS + Recurrent Miscarriage

Here are the biggest “root cause” areas I look at and these are often the missing pieces in mainstream advice.

1) Insulin Resistance and Blood Sugar Instability

This is one of the most common drivers in PCOS and one of the most ignored in recurrent loss.

Elevated insulin can impact:

• egg quality

• embryo development

• endometrial receptivity (implantation)

• inflammation

• placental development

And many women still aren’t tested properly — because glucose can look “normal” while insulin is elevated for years.

2) Low Progesterone + Short Luteal Phase

If you don’t ovulate consistently, progesterone is often low.

Progesterone supports:

• thickening of the uterine lining

• implantation

• early pregnancy stability

A short luteal phase (time from ovulation to period) can mean:your body isn’t sustaining the hormonal environment long enough to support pregnancy.

3) Thyroid Imbalances (Including Autoimmune Thyroid Issues)

This is a big one that gets missed.

Even “mild” thyroid dysfunction can increase miscarriage risk.

Thyroid health influences:

• ovulation

• implantation

• placental development

• fetal neurological development

And thyroid antibodies can be present even when TSH looks “fine” — which is why deeper testing matters.

4) Chronic Inflammation

Inflammation is a fertility barrier.

When inflammation is high, it can interfere with:

• implantation

• embryo development

• placental formation

• hormone signalling

This is also why some women with endometriosis experience loss even when they ovulate regularly.

5) Nutrient Depletion (You Can’t Grow a Baby From Empty)

I want to say this gently, but clearly:

Pregnancy is not a replenishing state. It is demanding.

Pregnancy (and postpartum) draws heavily from the mother’s nutrient stores. If you’re already depleted, which many women with PCOS are it becomes an uphill battle.

Common deficiencies I see in fertility + recurrent loss include:

• iron and ferritin

• B12

• folate

• vitamin D

• zinc

• magnesium

• iodine/selenium (case dependent)

Nutrients matter for:

• egg quality

• hormone production

• placental development

• methylation pathways

• stress resilience

6) MTHFR Gene Variants (and Why It’s Not the Whole Story)

MTHFR is one of the most talked about topics online and it’s also one of the most misunderstood.

Having an MTHFR variant does not automatically mean miscarriage. But it can mean that your body may struggle more with certain methylation pathways which can affect:

• folate metabolism

• homocysteine balance

• early pregnancy development

What matters most clinically is:

• your nutrient status

• folate form

• B vitamin levels

• homocysteine markers (where relevant)

This is where personalised guidance matters because the internet tends to catastrophise this gene variation and create fear.

7) Male Factor (Yes, It Matters More Than People Realise)

This is another area I get really passionate about because women carry almost all the fertility burden, and it’s not fair.

Recurrent miscarriage is not always “a female hormone issue.”

Male factor can contribute through:

• sperm DNA fragmentation

• oxidative stress

• poor sperm morphology/function

• inflammation and nutrient depletion in the male partner

Sperm quality impacts:

• embryo quality

• early development

• miscarriage risk

So if miscarriages keep happening, I believe both partners deserve assessment and support.

Testing Framework: What I Recommend Investigating

This is the part that changes everything: clarity.

Depending on your history, symptoms and losses, testing may include:

Metabolic testing

• fasting insulin + fasting glucose

• HbA1c

• OGTT with insulin markers (where appropriate)

Thyroid

• TSH

• free T4

• free T3

• thyroid antibodies (TPO + TgAb)

Progesterone

• progesterone 7 days post ovulation (not just “day 21”)

Nutrients

• iron studies + ferritin

• vitamin D

• B12 + folate

• zinc, magnesium (where appropriate)

Inflammation

• hs-CRP

• other inflammatory markers depending on case

Fertility hormones (case dependent)

• androgens (testosterone, free testosterone, SHBG, DHEA-S)

• prolactin

Male factor

• semen analysis

• DNA fragmentation (if indicated)

And in some cases, referrals and specialist investigation:

• endometriosis / adenomyosis screening

• pelvic imaging

• clotting factors (with GP/specialist)

How I Support You as a Naturopath (This is Where I Can Really Help)

This is not about a generic supplement list.

This is about supporting the entire fertility foundation so your body can conceive and sustain pregnancy.

1) Improve ovulation naturally

We support the drivers behind consistent ovulation:

• insulin sensitivity

• hormone balance

• inflammation reduction

• stress regulation

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2) Reduce inflammation and improve implantation environment

This can include:

• anti-inflammatory nutrition foundations

• gut and liver support

• omega-3 strategies

• targeted herbs and supplementation (personalised)

3) Personalised nutrition (not restriction)

Your body needs:

• stable blood sugar

• enough protein

• nutrient density

• inflammation support

• sustainable habits you can actually maintain

4) Herbs and supplements tailored to your testing

Support might include strategies for:

• progesterone support

• androgen balance

• insulin regulation

• egg quality and antioxidant protection

• nervous system support

But always individualised — because guessing is expensive and exhausting.

5) Supporting male factor

If we need to support sperm health, we look at:

• inflammation

• oxidative stress

• nutrient support

• lifestyle foundations that improve sperm quality over 3 months+

6) ERT: Processing grief, fear and trauma after loss

This part matters so much and it’s often missing in fertility care.

Miscarriage isn’t just a physical event. It’s emotional trauma.

After loss, many women carry:

• fear of trying again

• anxiety throughout the next pregnancy

• guilt and self-blame

• distrust in their body

• nervous system hypervigilance

ERT can support the emotional processing of miscarriage, help regulate the nervous system, and release the stuck grief, fear and trauma responses that often linger.

This is not about “thinking positive.”It’s about restoring emotional safety in the body.

Do You Need to Jump Straight to IVF?

Not always.

For some couples, IVF is absolutely the right next step and I fully support that.

But many women are pushed towards IVF quickly because:

• their cycles are irregular

• they’ve had miscarriages

• they’re told their hormones are “too hard”

When sometimes the missing piece is:

• improving insulin sensitivity

• strengthening ovulation

• restoring progesterone patterns

• reducing inflammation

• rebuilding nutrients

• supporting sperm quality

• addressing thyroid function

Your body may just need the right support and foundation.

And whether you conceive naturally or with medical support, you’ll be better prepared and more resilient with a strong preconception foundation.

Final Thoughts

Recurrent miscarriage with PCOS is not something you just “push through.”

You deserve investigation. You deserve answers.And you deserve a plan that supports both your physical body and your emotional wellbeing.

This journey is heavy but you don’t have to do it alone.

Ready to feel better and stop guessing?

Book a FREE Naturopathic PCOS Assessment Call and we’ll map out what could be contributing to recurrent miscarriage, what testing and investigation should be prioritised (including male factor), and how to support ovulation, reduce inflammation, rebuild nutrient stores and prepare your body for a healthy pregnancy — without rushing straight into IVF unless it’s truly necessary.