The effect of myo-inositol/di-chiro-inositol on markers of ovarian reserve in women with PCOS undergoing IVF/ICSI: A systematic review and meta-analysis.

Authors:
Priya Bhide
Priya Bhide
Homerton University Hospital
United Kingdom
Jyotsna Pundir
Jyotsna Pundir
Assisted Conception Unit
Anil Gudi
Anil Gudi
Homerton University Hospital
United Kingdom
Amit Shah
Amit Shah
Emory University
United States
Roy Homburg
Roy Homburg
Vrije Universiteit Medical Centre
Netherlands
Ganesh Acharya
Ganesh Acharya
University Hospital of Northern Norway
Norway

Acta Obstet Gynecol Scand 2019 Apr 16. Epub 2019 Apr 16.

Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.

Introduction: High levels of anti-Mullerian hormone and a high antral follicle count in women with polycystic ovary syndrome, reflecting increased ovarian antral follicles, predisposes them to have a high number of retrieved oocytes with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and an increased risk of ovarian hyperstimulation syndrome. Inositols, which act as insulin sensitizers, have the potential to alter folliculogenesis and the functional ovarian reserve, with subsequent benefits to reproductive outcomes following IVF/ICSI treatment. Published literature is, however, unable to provide definitive evidence of its efficacy. The objective of our review was to evaluate the effect of inositols on anti-Mullerian hormone, antral follicle count and reproductive outcomes in women with polycystic ovary syndrome undergoing IVF/ICSI.

Material And Methods: We performed a literature search using standard methodology recommended by Cochrane. Randomized controlled trials and non-randomized studies comparing inositols with no treatment, placebo or other treatment were included in the review. Using standard methodology recommended by Cochrane we pooled results using the random effects model; our findings were reported as relative risk or mean differences. PROSPERO registration: CRD42017082275.

Results: We included 18 trials. The primary outcome was a change in anti-Mullerian hormone and antral follicle count before and after treatment, for which data were unsuitable for meta-analysis. A narrative review showed no consistent direction or size of effect. A meta-analysis for the secondary outcomes showed no evidence of a significant difference between inositol and control groups for any outcome: number of oocytes (mean difference -0.39, 95% confidence interval [CI] -1.11 to 0.33), number of metaphase II oocytes (mean difference 0.29, 95% CI -0.83 to 1.40), number of top grade embryos (risk ratio [RR] 1.02, 95% CI 0.93-1.12), clinical pregnancy rate (RR 1.16, 95% CI 0.87-1.53), and risk of ovarian hyperstimulation syndrome (RR 0.73, 95% CI 0.39-1.37). The quality of evidence was assessed as very low.

Conclusions: There is insufficient evidence for an effect of inositols on ovarian reserve markers and to support their use as pretreatment before IVF/ICSI in women with polycystic ovary syndrome.

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http://dx.doi.org/10.1111/aogs.13625DOI Listing
April 2019
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References

(Supplied by CrossRef)
Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositol glycan mediators as the signal transduction system
Nestler JE et al.
J Clin Endocrinol Metab 1998
Randomized, double blind placebo‐controlled trial: effects of myo‐inositol on ovarian function and metabolic factors in women with PCOS
Gerli S et al.
Eur Rev Med Pharmacol Sci 2007

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