Prospective Randomized Study on the Influence of Myoinositol in PCOS Women Undergoing IVF in the Improvement of Oocyte Quality, Fertilization Rate, and Embryo Quality

Abstract

Polycystic ovarian syndrome (PCOS) is one of the pathological factors involved in the failure of in vitro fertilization (IvF). The aim of the present study was to investigate if the combination of myoinositol + folic acid was able to improve the oocyte quality, the ratio between follicles and retrieved oocytes, the fertilization rate, and the embryo quality in PCOS patients undergoing IvF treatments. 29 patients with PCOS underwent IvF protocols for infertility treatment and were randomized prospectively into two groups. Group A (placebo) with 15 patients and group B (4000 mg myoinositol + 400 μg folic acid per day) with 14 patients. The patients of group B used for two months myoinositol + folic acid before starting the IvF protocol and data were obtained concerning number of follicles, number of oocytes, quality of oocytes, fertilization rates, and embryo quality in both groups. The ratio follicle/retrieved oocyte was better in the myoinositol group (= group B). Out of the 233 oocytes collected in the myoinositol group 136 were fertilized, whereas only 128 out of 300 oocytes in the placebo group were fertilized. More metaphase II and I oocytes were retrieved in relation to the total amount of oocytes in the myoinositol. More embryos of grade I quality were obtained in the myoinositol. The duration of stimulation was 9,7 days (±3,3) in the myoinositol group and 11,2 (±1,8) days in the placebo group and the number of used FSH units was lower in the myoinositol group: 1750 FSH units (mean) versus 1850 units (mean). Our evidence suggests that myoinositol therapy in women with PCOS results in better fertilization rates and a clear trend to a better embryo quality. As the number of retrieved oocytes was smaller in the myoinositol group, the risk of hyper stimulation syndrome can be reduced in these patients.

Identification of Polycystic Ovary Syndrome (PCOS) Specific Genes in Cumulus and Mural Granulosa Cells

“…In case of risk of overhyperstimulation syndrome, 0.2 mg GnRH-agonist was used. Follicular puncture was performed exactly 35 hours after induction of ovulation [11]. …”

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

“…Isabella et al reported a significant decrease in the number of MII oocytes following treatment with DCI as compared with control. The results from Lesoine & Regidor are unclear. Alviggi et al in a non‐randomized study reported a significant increase in the number of MII oocytes following treatment with MI as compared with control ( P = 0.03).…”

“…Pacchiarotti et al reported no significant difference in the number of top grade embryos between the MI and control groups. Isabella et al reported a significant decrease in the number of top‐grade embryos following treatment with DCI ( P < 0.01) whereas Lesoine & Regidor reported a significantly higher number of top‐grade embryos following treatment with MI as compared with control ( P < 0.05). Unfer et al reported a significantly higher number of top‐grade embryos following treatment with MI than treatment with DCI ( P < 0.01).…”

“…Studies by Ciotta and Lesoine & Regidor were not included in the meta‐analysis as trial data were not available in a format suitable for meta‐analysis. Ciotta reported a significantly higher number of oocytes in the MI treated group as compared with control ( P < 0.05), whereas Lesoine & Regidor reported a higher number of oocytes in the control group than in the MI group. Alviggi et al in a non‐randomized study reported no significant difference between the MI and control groups ( P = 0.23).…”

“…Statistical significance was assumed when P < 0.05. When published articles were unclear about the presence and amount of missing data, the original investigators [16][17][18][19][20][21][22][23][24][25] of the trial were contacted to request this information. We were able to get this information from Colazingari et al, 18 Ozay et al 21 have updated the risk of bias accordingly.…”