Effectiveness of Metformin in Recurrent Miscarriage in a Woman With Hyperinsulinaemia

Inclusion Criteria: * women who are diagnosed to have PCOS and/or haven hyper insulinaemia and have a previous history of recurrent miscarriages. Exclusion Criteria: * Any patients with PCOS or hyper insulinaemia previously treated by any forms of insulin sensitizers. Age above forty years old . * Antiphospholipid syndrome (lupus anticoagulant and/or anticardiolipin antibodies \[IgG or IgM\]); other recognised thrombophilic conditions (testing according to usual clinic practice). * Intrauterine abnormalities (as assessed by ultrasound, hysterosonography, hysterosalpingogram, or hysteroscopy). * Fibroids distorting uterine cavity . * Abnormal parental karyotype . * Other identifiable causes of recurrent miscarriages (tests initiated only if clinically indicated) e.g., diabetes, thyroid disease and systemic lupus erythematosus (SLE).