الفهرس 
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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
We conducted this Case control study to evaluate the relation between insulin resistance and the recurrent pregnancy loss in a group of patients whom diagnosis was unexplained recurrent miscarriage. On 80 non-pregnant women classified into two groups: group A (Case group): 40 non-pregnant females presenting with history of recurrent pregnancy loss and group B (Control group): 40 non-pregnant females with no history of abortion with at least one living baby.
All patients in both groups were tested for fasting glucose (FG) and fasting insulin levels (FI). Based on these tests, the HOMA-IR (homeostasis model assessment of insulin resistance) index
Our results showed that;
No significant differences between the studied groups regarding age and BMI (p= 0.375, 0.141 & 0.056 respectively). On the other hands, Gravidity was significantly higher among RPL cases (six versus two, p<0.001). While Parity (two versus one, p<0.001) and living (two versus one, p<0.001) were significantly higher among control cases.
Fasting blood glucose was significantly higher among RPL cases (110.7±9.0) than control group (106.9±6.3) as p=0.035. Fasting insulin was significantly higher among RPL cases (13.2±6.1) than control group (8.5±3.5) as p<0.001.
HOMA-IR was significantly higher among RPL cases (3.7±1.9) than control group (2.3±1.0) as p<0.001. Insulin resistance was significantly more frequent among RPL cases (13 (32.5%)) than control group (4 (10.0%)) as p=0.014.
Glucose insulin ratio was significantly lower among RPL cases (10.7±6.1) than control group (14.0±3.8) as p=0.004.
Non-significant negative correlation between number of previous miscarriages and BMI (r =-0.168&p= 0.468), FI (r =-0.210&p= 0.193) and HOMA-IR (r =-0.174&p= 0.284) among RPL case group. On the other hands, there was Non-significant positive correlation between number of previous miscarriages and age (r=0.118&p=0.468), FBG (r =0.051&p= 0.755) & Glucose insulin ratio (r =0.315 & p=0.058) among RPL case group.
FBG, IR, HOMA-IR and glucose insulin ratio cutoff points had low diagnostic characteristics in differentiating RPL cases from control.
We concluded that;
In conclusion, the present study showed significantly higher IR, HOMA-IR, glucose and insulin in patients with RPL compared with the control group.
These results are important for practitioners in determining the diagnosis and choice of treatment for RPL patients because IR may require treatment that includes life style changes, exercise, and metformin drug therapy.