Does the combination of myo-inositol improve pregnancy outcomes in obese polycystic ovary syndrome women undergoing ovarian stimulation with clomiphene citrate?

Authors

Keywords:

Polycystic ovary syndrome, Ovarian stimulation, Clomiphene citrate, Myo-inositol

Abstract

Aim: Recent evidence has shown that Myoinositol (MI), a nutrient belonging to vitamin B family, may improve hormone profile, and the metabolic disorders accompanying polycystic ovary syndrome (PCOS), probably through the amelioration of preexisting insulin resistance. This study aimed to compare the ovulation and pregnancy outcomes of clomiphene citrate (CC) and its combination with MI in obese PCOS women with infertility. 

Methods: Data concerning 80 obese, PCOS women with infertility who had undergone ovarian induction were retrieved from the institutional digital database. Controlled ovarian stimulation (OS) was performed using CC 100 mg or CC (100mg) + MI (4 g). The primary outcome measure of this study was the difference in the ovulation and the pregnancy rates of the women receiving CC (CC group) or CC+MI (combination group) for ovarian stimulation. There were 40 patients in each group. 

Results: Endometrial thickness was significantly higher in the combination group than in the CC group (8.4 (1.1) mm vs. 7.7 (1.2) mm, P=0.006) and the number of the follicles>17 mm following OS was significantly higher in the combination group compared to that of the CC group (1.6 (0.5) vs. 1.4 (0.5), P=0.036). However, the rate of ovulation following OS [37 (92%) vs. 37 (92%), P=1.000] and the rate of the pregnancy were similar in CC and combination groups [6 (15%) vs. 11 (27.5%), P=0.172, respectively].

Conclusions: Compared to ovarian stimulation with CC alone, the combination provides a beneficial effect on endometrial thickness and the number of mature follicles. However, ovulation rates are similar with the two regimens. Although not statistically significant, there was a trend towards higher rates of pregnancy on CC+MI combination compared to CC alone. Further prospective and randomized trials are required to clearly address the role of the MI in management of the PCOS women with infertility.

Downloads

Download data is not yet available.

References

March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25:544-51.

McCartney M, Marshall CRJC. Clinical Practice. Polycystic Ovary Syndrome. N Engl J Med. 2016;375:54-64.

Anagnostis P, Tarlatzis BC, Kauffman RP. Polycystic ovarian syndrome (PCOS): Long-term metabolic consequences. Metabolism. 2018;86:33-43.

Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90:1929-35.

Baillargeon JP, Nestler JE. Commentary: polycystic ovary syndrome: a syndrome of ovarian hypersensitivity to insulin? J Clin Endocrinol Metab. 2006;91:22-4.

Bergh CM, Moore M, Gundell C. Evidence-Based Management of Infertility in Women With Polycystic Ovary Syndrome. J Obstet Gynecol Neonatal Nurs. 2016;45:111-22.

Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab. 2000;85:2434-8.

Nandi A, Chen Z, Patel R, Poretsky L. Polycystic ovary syndrome. Endocrinol Metab Clin North Am, 2014;43:123-47.

Brewer CJ, Balen AH. The adverse effects of obesity on conception and implantation. Reproduction. 2010;140:347-64.

Pasquali R, Patton L, Gambineri A. Obesity and infertility. Curr Opin Endocrinol Diabetes Obes. 2007;14:482-7.

Imani B, Eijkemans MJ, Velde ER, Habbema JD, Fauser BC. Predictors of chances to conceive in ovulatory patients during clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. J Clin Endocrinol Metab. 1999;84:1617-22.

Bıldırcın FD, Özdemir A, Karlı P, Çetinkaya MB. Breast cancer and ovulation induction. Journal of Surgery and Medicine. 2019;3:612-8.

Costantino D, Minozzi MB, Minozzi E, Guaraldi C. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009;13:105-10.

Zeng L, Yang K. Effectiveness of myoinositol for polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018;59:30-8.

Benelli E, Del Ghianda S, Di Cosmo C, Tonacchera M. A Combined Therapy with Myo-Inositol and D-Chiro-Inositol Improves Endocrine Parameters and Insulin Resistance in PCOS Young Overweight Women. Int J Endocrinol.2016;2016:3204083.

Iuorno MJ, Jakubowicz DJ, Baillargeon JP, Dillon P, Gunn R.D, Allan G, et al. Effects of d-chiro-inositol in lean women with the polycystic ovary syndrome. Endocr Pract. 2002;8:417-23.

The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril.2004;81:19-25.

Nakamura Y, Ono M, Yoshida Y, Sugino N, Ueda K, Kato H. Effects of clomiphene citrate on the endometrial thickness and echogenic pattern of the endometrium. Fertil Steril. 1997;67:256-60.

ESHRE Capri Workshop Group, Health and fertility in World Health Organization group 2 anovulatory women. Hum Reprod Update. 2012;18:586-99.

Kumar P, Nawani N, Malhotra N, Malhotra J, Patil M, Jayakrishnan K, et al. Assisted reproduction in polycystic ovarian disease: A multicentric trial in India. J Hum Reprod Sci. 2013;6:49-53.

Siristatidis CS, Vrachnis N, Creatsa M, Maheshwari A, Bhattacharya S. In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction. Cochrane Database Syst Rev.2013;10.1002/14651858.CD006606.pub3: Cd006606.

Baumgarten M, Polanski L, Campbell B, Raine-Fenning N. Do dopamine agonists prevent or reduce the severity of ovarian hyperstimulation syndrome in women undergoing assisted reproduction? A systematic review and meta-analysis. Hum Fertil (Camb). 2013;16:168-74.

Jayaprakasan K, Chan Y, Islam R, Haoula Z, Hopkisson J. Coomarasamy , A., et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril. 2012;98:657-63.

Kousta E, White DM, Franks S. Modern use of clomiphene citrate in induction of ovulation. Hum Reprod Update. 1997;3:359-65.

Massai MR, de Ziegler D, Lesobre V, Bergeron C, Frydman R, Bouchard P. Clomiphene citrate affects cervical mucus and endometrial morphology independently of the changes in plasma hormonal levels induced by multiple follicular recruitment. Fertil Steril. 1993;59:1179-86.

Emekci Ozay O, Ozay AC, Cagliyan E, Okyay RE, Gulekli B. Myo-inositol administration positively effects ovulation induction and intrauterine insemination in patients with polycystic ovary syndrome: a prospective, controlled, randomized trial. Gynecol Endocrinol. 2017;33:524-8.

Imani B, Eijkemans MJ, te Velde ER, Habbema JD, Fauser BC. A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Fertil Steril. 2002;77:91-7.

Belva F, Roelants M, De Schepper J, Van Steirteghem A, Tournaye H, Bonduelle M. Reproductive hormones of ICSI-conceived young adult men: the first results. Hum Reprod. 2017;32:439-46.

Himabindu Y, Sriharibabu M, Gopinathan K, Satish U, Louis TF, Gopinath P. Anti-mullerian hormone and antral follicle count as predictors of ovarian response in assisted reproduction. J Hum Reprod Sci. 2013;6:27-31.

Li J, Li R, Yu H, Zhao S, Yu Y, Qiao J. The relationship between serum anti-Mullerian hormone levels and the follicular arrest for women with polycystic ovary syndrome. Syst Biol Reprod Med. 2015;61:103-9.

Downloads

Published

2019-09-01

Issue

Section

Research Article

How to Cite

1.
Taş M, Özçelik B. Does the combination of myo-inositol improve pregnancy outcomes in obese polycystic ovary syndrome women undergoing ovarian stimulation with clomiphene citrate?. J Surg Med [Internet]. 2019 Sep. 1 [cited 2022 Sep. 28];3(9):707-10. Available from: https://jsurgmed.com/article/view/624097