Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials

Table 4

IVF parameters and fertilization outcomes.

Ref	Treatment	E2 (pg/mL)		r-FSH dose (IU)	Stimulation days	MII	Oocyte retrieved	Embryo grade 1	Biochemical pregnancy (%)	Pregnancy rate (%)	General findings
[25]	Myo-Ins; versus; FA	2,232 ± 510; versus; 2,713 ± 595		1,958 ± 695; versus; 2,383 ± 578	11.4 ± 0.9; versus; 12.4 ± 1.4	7.14 ± 3.49; versus; 7.07 ± 3.04	8.76 ± 4.12; versus; 9.37 ± 3.31	0.86 ± 0.83; versus; 0.81 ± 0.83	9.1; versus; 10	14.6; versus; 12.9	Myo-Ins significantly reduced E2 at hCG administration, total r-FSH units, number of stimulation days, and number of VG-DEG, with a trend for increased percentage of oocytes in MII. Number of oocytes retrieved did not differ in the 2 groups.
[26]	Myo-Ins; versus; FA	Reduced in; Myo-Ins group; versus; control		Reduced in; Myo-Ins group; versus; control	NA	82.24%; versus; 66.87%	12; versus; 8.50	68.1%; versus; 29%	No; differences	NA	Myo-Ins has a positive effect on mature oocytes development and reduction of E2 and total r-FSH. Number of follicles with a diameter >15 mm visible at ultrasound scan during stimulation and the number of oocytes retrieved at the pick-up resulted significantly higher in the Myo-Ins-treated group. The number of immature oocytes was significantly reduced, and there was an increasing trend of the rate of oocytes in MII.
[27]	Myo-Ins; versus; metformin	NA		3 cycles × 37.5 U/day; (if no pregnancy occurred)	NA	NA	NA	NA	30; versus; 18.3	48.3; versus; 36.6	Both Myo-Ins and metformin can be considered as first-line treatment for restoring normal menstrual cycles in most patients with PCOS; however Myo-Ins treatment seems to be more effective than metformin.
[28]	D-chiro-Ins (2400 mg); versus; placebo	1,490.24 ± 253.21; versus; 1,429.69 ± 1,118.43		2,983.0 ± 219.80; versus; 2,239.7 ± 181.55	13.8 ± 0.87; versus; 11.4 ± 1.2	Decreased progressively after; D-chiro-Ins administration	No differences	Decreased progressively after D-chiro-Ins administration	NA	NA	High D-chiro-Ins dosage negatively affects oocyte quality. It worsens oocyte quality and ovarian response in nonobese and non-insulin resistant PCOS women.
[29]	Myo-Ins; versus; D-chiro-Ins	2,261.2 ± 456.6; versus; 2,740 ± 396.67		1,953.6 ± 397.5; versus; 2,360.5 ± 301.9	11.1 ± 0.8; versus; 12.7 ± 1.1	8.21 ± 2.39; versus; 7.08 ± 2.67	8.90 ± 2.84; versus; 9.32 ± 3.15	1.64 ± 0.88; versus; 0.76 ± 0.43	14; versus; 9	51; versus; 24	Myo-Ins significantly increased number of MII and decreased number of immature oocytes compared to D-chiro-Ins. Furthermore, it increased the mean number of top quality embryos and the total number of pregnancies compared to D-chiro-Ins. Number of oocytes retrieved did not differ in the two treatments groups.
[30]	Myo-Ins +; D-chiro-Ins; versus; D-chiro-Ins	Age; ≤35	2,230.09 ± 827.57; versus; 2,537.94 ± 860.19	1,569.02 ± 497.12; versus; 1,899.21 ± 618.17	NA	7.91 ± 4.51; versus; 8.00 ± 3.92	9.91 ± 4.85; versus; 10.79 ± 4.66	0.96 ± 0.83; versus; 0.73 ± 0.73	NA	NA	The combined treatment with Myo-Ins + D-chiro-Ins, rather than D-chiro-Ins alone, was able to improve oocyte quality and high-quality embryos in PCOS women undergoing ART regardless of the age.
		Age; ≥35	2,185.09 ± 409.08; versus; 2,519.85 ± 788.49	1,906.96 ± 770.59; versus; 2,170.58 ± 694.44	NA	6.91 ± 2.26; versus; 8.35 ± 5.19	8.35 ± 3.21; versus; 10.75 ± 5.23	0.90 ± 0.80; versus; 0.68 ± 0.80	NA	NA

Myo-Ins, myo-inositol; D-chiro-Ins, D-chiro-inositol; FA, folic acid; PCOS, polycystic ovary syndrome; E2, oestradiol; r-FSH, recombinant follicle stimulating hormone; MII, mature oocytes; VG-DEG, immature oocytes and degenerated oocytes; hCG, Human Chorionic Gonadotropin; ART, assisted reproductive technology.
Values are mean ± SD. Values are shown as median. A brief description is inserted in the table when numerical data are not available.
value: ≤0.05; ≤0.01; ≤0.001: comparison posttreatment experimental group versus control.