Successful Pregnancy Outcome in a Patient with Recurrent Miscarriage Due to PCOS Complicated by Hereditary Protein C Deficiency

On December 28, 2016, a 35-year-old female patient presenting with chest pain and a brief fainting spell was admitted to a hospital in Guangzhou and promptly received thrombectomy and catheter-directed thrombolysis. She had experienced two episodes of explosive thrombosis, with the second occurring in May 2020, triggered by pregnancy. Her diagnoses included polycystic ovary syndrome (PCOS), hereditary Protein C (PC) deficiency resulting from a heterozygous mutation deletion of 572_574 in exon 7, recurrent spontaneous abortion (RSA), as well as PCOS-associated insulin resistance and chronic endometritis. Our regimen comprises dydrogesterone for cycle regulation, rivaroxaban for PC deficiency-related thrombophilia, and metformin, amoxicillin, and omeprazole to manage PCOS-associated insulin resistance and chronic endometritis, with the aim of mitigating their contribution to impaired endometrial receptivity. Following our targeted and persistent treatment, the patient gave birth to a healthy baby in April 2023. It is rare for RSA to be caused by PCOS complicated by hereditary PC deficiency, and there are no international treatment guidelines for such cases. This report adds to the existing body of knowledge regarding the treatment of PCOS complicated by hereditary PC deficiency. For RSA patients, a comprehensive approach considering all contributing factors and individual circumstances is essential. Multi-disciplinary treatment (MDT) is crucial. Moreover, there are currently no international, evidence-based guidelines for the use of combined oral contraceptives (COCs) in PCOS complicated by hereditary thrombophilia, highlighting the urgent need for multicenter clinical studies to establish appropriate management strategies.