Abstract
Purpose of Investigation: The objective of this prospective controlled observational study was to evaluate the effect of myoinositol supplementation on intracytoplasmic sperm injection (ICSI) outcome in Japanese infertile polycystic ovarian syndrome (PCOS) women with non-obese less-androgenic phenotype, which is common in East Asia. Materials and Methods: The ICSI outcome in the first treatment cycle under a flexible gonadotropin-releasing hormone antagonist protocol was compared between 25 PCOS women taking 4 g/day myoinositol + 400 μg/day folic acid (Myo/FA group) and 25 PCOS women taking 400 μg/day FA alone (FA Group). Results: The total dosage of human menopausal gonadtropin was significantly lower in the Myo/FA group than in the FA group (p = 0.034). The number (p = 0.000029) and rate (relative risk 1.47, 95% confidence interval 1.43-1.50, p < 0.0001) of metaphase II oocytes and the number of fertilized oocytes (p = 0.0074) was significantly higher in the Myo/FA group than in the FA group. Conclusion: Myoinositol supplementation is a safe and effective treatment modality to increase the mature and fertilized oocytes, along with a reduction in the gonadotropin dose in ICSI cycles in Japanese infertile PCOS women with non-obese less-androgenic phenotype.
Highlights
Polycystic ovarian syndrome (PCOS) is a pathologic condition characterized by chronic anovulation/oligo-ovulation, hyperandrogenism, and ultrasonic polycystic ovarian features
Studies found that the hyperactivity of epimerase in ovarian theca cells in women with PCOS is associated with a consistent myoinositol deficiency and is responsible for anovulation/oligo-ovulation and low oocyte quality in this pathologic condition [3, 4]
While the duration of controlled ovarian stimulation and peak estradiol concentration were similar between the two groups (Table 2), the total dosage of human menopausal gonadotropin (hMG) was lower in the Myo/FA group than in the FA group (1748 ± 306 IU vs. 1937 ± 298 IU, p = 0.034)
Summary
Inositols are a group of sugar alcohols, which are subdivided into nine stereoisomers according to the positioning of the hydroxyl group. Polycystic ovarian syndrome (PCOS) is a pathologic condition characterized by chronic anovulation/oligo-ovulation, hyperandrogenism, and ultrasonic polycystic ovarian features. Studies found that the hyperactivity of epimerase in ovarian theca cells in women with PCOS is associated with a consistent myoinositol deficiency and is responsible for anovulation/oligo-ovulation and low oocyte quality in this pathologic condition [3, 4]. This theory is supported by the positive correlation between the follicular fluid myoinositol concentration and oocyte quality [5]. Myoinositol supplementation is emerging as a promising tool to improve the ovulation disorders, oocyte quality, and pregnancy outcome in infertile PCOS women in Western countries [6]
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