Efficacy of Myo-inositol in Improving Pregnancy Rate and Regulation of Menstrual Cycle for Patients With Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis


Background: Polycystic ovarian syndrome (PCOS) is a common, reproductive endocrinopathy associated with ovarian dysfunction, cardiovascular disorders, obesity, and infertility. Myo-inositol is a novel treatment for women with PCOS that claimed to have improved fertility rate in this population. This systematic review and meta-analysis examined the effect of myo-inositol on pregnancy rate, menstrual cycle, and adverse effects from randomized controlled trials (RCTs).

Methods: RCTs that evaluated the efficacy of myo-inositol in improving pregnancy rate and regulation of menstrual cycle in women with PCOS. Electronic databases were searched and studies published up to October 24, 2021 were included in the systematic review and meta-analysis. Study selection and assessment of quality were conducted independently by two review authors.

Results: Seven studies with 729 patients treated with myo-inositol and 677 patients treated with placebo and/or metformin were included in the analysis. The research groups did not diverge significantly in terms of basic characteristics, such as age, adnexal or uterine pathology, body mass index, and duration of infertility. In the myo-inositol group, regulation of the normal menstrual cycle is at 20%, significantly higher than the metformin group at 12%, (p<0.001). However, there is no significant difference in the pregnancy rate between myoinositol and placebo (p=0.42) and/or metformin (p=0.17).

Conclusion: This systematic review and meta-analysis showed that myo-inositol can be an alternative treatment for PCOS in terms of regulation of menses and may improve the success of spontaneous pregnancies. However, additional randomized, double-blind controlled trials with larger sample sizes, low heterogeneity, and uniform inclusion criteria are recommended to establish the effects of myo-inositol on PCOS treatment and pregnancy rate.

Key words: Polycystic ovarian syndrome, PCOS, pregnancy rate, myo-inositol, menstrual regulation, menstrual cycle, randomized control trial, RCT

  1. Sortino MA, Salomone S, Carruba MO, Drago F. Polycystic ovary syndrome: Insights into the therapeutic approach with inositols. Front Pharmacol [Internet]. 2017;8:341. Available from: http://dx.doi.org/10.3389/fphar.2017.00341
  2. Agrawal A, Mahey R, Kachhawa G, Khadgawat R, Vanamail P, Kriplani A. Comparison of metformin plus myoinositol vs metformin alone in PCOS women undergoing ovulation induction cycles: randomized controlled trial. Gynecol Endocrinol [Internet]. 2019;35(6):511–4. Available from: http://dx.doi.org/10.1080/09513590.2018.1549656
  3. Regidor P-A, Schindler AE. Myoinositol as a safe and alternative approach in the treatment of infertile PCOS women: A German observational study. Int J Endocrinol [Internet]. 2016;2016:9537632. Available from: http://dx.doi.org/10.1155/2016/9537632
  4. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ [Internet]. 2003;327(7414):557–60. Available from: http://dx.doi.org/10.1136/bmj.327.7414.557
  5. El Hayek S, Bitar L, Hamdar LH, Mirza FG, Daoud G. Polycystic ovarian syndrome: An updated overview. Front Physiol [Internet]. 2016;7:124. Available from: http://dx.doi.org/10.3389/fphys.2016.00124
  6. Shurrab NT, Arafa E-SA. Metformin: A review of its therapeutic efficacy and adverse effects. Obes Med [Internet]. 2020;17(100186):100186. Available from: http://dx.doi.org/10.1016/j.obmed.2020.100186
  7. Facchinetti F, Orrù B, Grandi G, Unfer V. Short-term effects of metformin and myo-inositol in women with polycystic ovarian syndrome (PCOS): a meta-analysis of randomized clinical trials. Gynecol Endocrinol [Internet]. 2019;35(3):198–206. Available from: http://dx.doi.org/10.1080/09513590.2018.1540578
  8. Haas DA, Carr BR, Attia GR. Effects of metformin on body mass index, menstrual cyclicity, and ovulation induction in women with polycystic ovary syndrome. Fertil Steril [Internet]. 2003;79(3):469–81. Available from: http://dx.doi.org/10.1016/s0015-0282(02)04800-8
  9. Azizi Kutenaei M, Hosseini Teshnizi S, Ghaemmaghami P, Eini F, Roozbeh N. The effects of myo-inositol vs. metformin on the ovarian function in the polycystic ovary syndrome: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci [Internet]. 2021;25(7):3105–15. Available from: http://dx.doi.org/10.26355/eurrev_202104_25565
  10. Laganà AS, Rossetti P, Sapia F, Chiofalo B, Buscema M, Valenti G, et al. Evidence-based and patient-oriented inositol treatment in polycystic ovary syndrome: Changing the perspective of the disease. Int J Endocrinol Metab [Internet]. 2017;15(1):e43695. Available from: http://dx.doi.org/10.5812/ijem.43695
  11. Zacchè MM, Caputo L, Filippis S, Zacchè G, Dindelli M, Ferrari A. Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome. Gynecol Endocrinol [Internet]. 2009;25(8):508–13. Available from: http://dx.doi.org/10.1080/09513590903015544
  12. Merviel P, James P, Bouée S, Le Guillou M, Rince C, Nachtergaele C, et al. Impact of myo-inositol treatment in women with polycystic ovary syndrome in assisted reproductive technologies. Reprod Health [Internet]. 2021;18(1):13. Available from: http://dx.doi.org/10.1186/s12978-021-01073-3
  13. Carlomagno G, Nordio M, Chiu TT, Unfer V. Contribution of myo-inositol and melatonin to human reproduction. Eur J Obstet Gynecol Reprod Biol [Internet]. 2011;159(2):267–72. Available from: http://dx.doi.org/10.1016/j.ejogrb.2011.07.038
  14. Chirania K, Misra S, Behera S. A randomised clinical trial comparing myoinositol and metformin in PCOS. Int J Reprod Contracept Obstet Gynecol [Internet]. 2017;6(5):1814. Available from: http://dx.doi.org/10.18203/2320-1770.ijrcog20171563
  15. Akbari Sene A, Tabatabaie A, Nikniaz H, Alizadeh A, Sheibani K, Mortezapour Alisaraie M, et al. The myo-inositol effect on the oocyte quality and fertilization rate among women with polycystic ovary syndrome undergoing assisted reproductive technology cycles: a randomized clinical trial. Arch Gynecol Obstet [Internet]. 2019;299(6):1701–7. Available from: http://dx.doi.org/10.1007/s00404-019-05111-1
  16. Emekçi Özay Ö, Özay AC, Çağlıyan E, Okyay RE, Gülekli B. Myo-inositol administration positively effects ovulation induction and intrauterine insemination in patients with polycystic ovary syndrome: a prospective, controlled, randomized trial. Gynecol Endocrinol [Internet]. 2017;33(7):524–8. Available from: http://dx.doi.org/10.1080/09513590.2017.1296127
  17. Pacchiarotti A, Carlomagno G, Antonini G, Pacchiarotti A. Effect of myo-inositol and melatonin versus myo-inositol, in a randomized controlled trial, for improving in vitro fertilization of patients with polycystic ovarian syndrome. Gynecol Endocrinol [Internet]. 2016;32(1):69–73. Available from: http://dx.doi.org/10.3109/09513590.2015.1101444
  18. Pourghasem S, Bazarganipour F, Taghavi SA, Kutenaee MA. The effectiveness of inositol and metformin on infertile polycystic ovary syndrome women with resistant to letrozole. Arch Gynecol Obstet [Internet]. 2019;299(4):1193–9. Available from: http://dx.doi.org/10.1007/s00404-019-05064-5
  19. Thalamati S. A comparative study of combination of Myo-inositol and D-chiro-inositol versus metformin in the management of polycystic ovary syndrome in obese women with infertility. Reprod Endocrinol [Internet]. 2020;0(56):96–9. Available from: http://dx.doi.org/10.18370/2309-4117.2020.56.96-99
  20. Kutateladze TG. Translation of the phosphoinositide code by PI effectors. Nat Chem Biol [Internet]. 2010;6(7):507–13. Available from: http://dx.doi.org/10.1038/nchembio.390 


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