<p>Background: Infertility and miscarriage are common complications in women with PCOS, and may be linked with metabolic status and thyroid function. However, the role of ANGPTL6 in PCOS-related infertility and miscarriage remains underexplored. Study assessed serum ANGPTL6 levels in Iranian PCOS patients and its association with miscarriage, infertility, and thyroid dysfunction.<br /> Methods: This case-control study included 116 PCOS women (58 with infertility, 58 with a history of miscarriage) and 58 non-PCOS controls. The measurement of ANGPTL6, adiponectin, fasting insulin, and other hormonal parameters were measured using ELISA. Parametric data were analyzed with t-tests and ANOVA, and non-parametric data with Mann-Whitney and Kruskal-Wallis tests. Correlations were assessed using Pearson and Spearman tests. Logistic regression was used predicted PCOS risk. A p&lt;0.05 was considered statistically significant.<br /> Results: ANGPTL6 levels were significantly higher in the PCOS group (48.72&plusmn; 21.41 <em>ng/ml</em>) and the PCOS-miscarriage subgroup (50.16&plusmn;19.57 <em>ng/ml</em>) compared to the non-PCOS group (41.56&plusmn;14.74 <em>ng/ml</em>). T4 levels were significantly lower in the PCOS group (2.5&plusmn;1.9<em> &mu;g/dl</em>) compared to controls (3.9&plusmn;4.6 <em>&mu;g/dl</em>, p&lt;0.001). No significant correlation was found between ANGPTL6 and thyroid function tests. A positive correlation was observed between ANGPTL6 and adiponectin in the PCOS group (p&lt;0.01). Logistic regression showed a significant association between ANGPTL6 and the risk of PCOS (OR: 1.02, 95%CI: 1.002-1.038), even after adjusting for age, body mass index (BMI), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR).&nbsp;<br /> Conclusion: Elevated ANGPTL6 levels were correlated with PCOS. Future research is needed to explore the molecular pathways linking ANGPTL6 to PCOS and its interaction with metabolic biomarkers.</p>