DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20222785
Published: 2022-10-28

Effects of metformin plus myo-inositol compared to metformin alone as pre-treatment of ovulation induction in polycystic ovary syndrome with insulin resistance

Chalontika Rani, Farzana Deeba, Shakeela Ishrat, Jesmine Banu, Shirin Jahan, Sohely Nazneen, Sumaiya Akter, Priyanka Chowdhury

Abstract


Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting reproductive-age women. Insulin resistance (IR) is a common disorder, which may impair female fertility by causing ovulatory dysfunction. Lifestyle modification and insulin sensitizers are commonly used in the management of IR. This study aimed to compare the effects of metformin plus myo-inositol versus metformin alone as pre-treatment in ovulation induction in polycystic ovary syndrome with insulin resistance.

Methods: This prospective quasi-experimental study was conducted in the department of reproductive endocrinology and infertility, Bangabandhu Sheikh Mujib Medical University, Dhaka, from July 2020 to June 2021. A total of 52 insulin-resistant infertile PCOS women were included in this study, who were allocated into two groups by using odd-even numbers and given two different treatments.

Results: Mature follicles and mid-luteal serum progesterone levels were significantly higher in metformin plus myo-inositol group (60.9% versus 28.0% and (73.9% versus 44.0%) respectively. The ovulation rate was significantly higher in metformin plus myo-inositol group (73.9% versus 44.0%), and the pregnancy rate was higher in metformin plus myo-inositol group (26.92% versus 11.54%), but the difference was not statistically significant.

Conclusions: Ovulation rate was significantly higher in metformin plus myo-inositol group than metformin alone group. The pregnancy rate was higher in metformin plus myo-inositol group but no significant difference was found between the two groups.


Keywords


Insulin resistance, Metformin, Myo-inositol, Ovulation induction, PCOS

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References


Shannon M, Wang Y. Polycystic ovary syndrome: a common but often unrecognized condition. J Midwife Women’s Health. 2012;57(3):221-30.

Gayathri SR, Tripathy S, Muthulakshmi M. A comparative study of ovulation induction with clomiphene versus clomiphene and bromocriptine in follicular phase of normoprolactinemic PCOS women. Int J Reprod Contracept Obstet Gynecol. 2017;6(8):3464-8.

Guan HY, Zhang W, Huang BQ. Induction of ovulation with clomiphene citrate combined with bromocriptine in polycystic ovary syndrome patients with infertility: a prospective, randomized, and controlled clinical trial. Reprod Develop Med. 2017;1(04):216-20.

The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group Revised 2003 consensus. Diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19:41-7.

Taylor HS, Pal L, Seli E. Chronic Anovulation and the Polycystic Ovary Syndrome. In: Speroff’s Clinical Gynecologic Endocrinology and Infertility. 9th ed. Wolters Kluwer: India; 2020:405-414.

Ciampelli M, Fulghesu AM, Cucinelli F, Pavone V, Ronsisvalle E, Guido M, et al. Impact of insulin and body mass index on metabolic and endocrine variables in polycystic ovary syndrome. Metabolism. 1999; 48(2):167-72.

Genazzani AD, Battaglia C, Malavasi B, Strucchi C, Tortolani F, Gamba O. Metformin administration modulates and restores luteinizing hormone spontaneous episodic secretion and ovarian function in nonobese patients with polycystic ovary syndrome. Fertil Steril. 2004;81(1):114-9.

Nestler JE, Stovall D, Akhter N, Iuorno MJ, Jakubowicz DJ. Strategies for the use of insulin-sensitizing drugs to treat infertility in women with polycystic ovary syndrome. Fertil Steril. 2002;77(2):209-15.

Cheang KI, Sharma ST, Nestler JE. Is metformin a primary ovulatory agent in patients with polycystic ovary syndrome? Gynecol Endocrinol. 2006;22(11):595-604.

Harborne L, Fleming R, Lyall H, Norman J, Sattar N. Descriptive review of the evidence for the use of metformin in polycystic ovary syndrome. Lancet. 2003;361(9372):1894-901.

Unfer V, Porcaro G. Updates on the myo-inositol plus D-chiro-inositol combined therapy in polycystic ovary syndrome. Exp Rev Clin Pharmacol. 2014;7(5):623-31.

Papaleo E, Unfer V, Baillargeon JP, Chiu TT. Contribution of myo-inositol to reproduction. Eur J Obstet Gynecol Reprod Biol. 2009;147(2):120-3.

Begum MR, Ehsan N, Mariya E, Sharif AB. Efficacy of pre-treatment of insulin resistant PCOS patients by metformin alone versus metformin plus myo-inositol before induction of ovulation. Online J Gynecol Obstet Matern Care. 2020;3(1):180016.

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. 2019;35(6):511-4.

Nagaria T, Mohapatra A, Jaiswal J. Effect of myoinositol and metformin in combination on clinical and hormonal profile in patients of polycystic ovarian syndrome. Int J Reprod Contracept Obstet Gynecol. 2019;8(2):702-10.

Thakur SS, Anjum S, Siddiqui SS. Randomised controlled trial: comparing effects of metformin versus myoinositol versus metformin and myoinositol on ovarian functions and metabolic factors in polycystic ovarian syndrome. Int J Reprod Contracept, Obstet Gynecol. 2020;9(6):2542-50.

Prabhakar P, Mahey R, Gupta M, Khadgawat R, Kachhawa G, Sharma JB, et al. Impact of myoinositol with metformin and myoinositol alone in infertile PCOS women undergoing ovulation induction cycles-randomized controlled trial. Gynecol Endocrinol. 2021;37(4):332-6.

Ozay OE, 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. 2017;33(7):524-8.

Artini PG, Di Berardino OM, Papini F, Genazzani AD, Simi G, Ruggiero M, et al. Endocrine and clinical effects of Myo-inositol administration in polycystic ovary syndrome. A randomized study. Gynecol Endocrinol. 2013;29(4):375-9.

Kamenov Z, Kolarov G, Gateva A, Carlomagno G, Genazzani AD. Ovulation induction with myo-inositol alone and in combination with clomiphene citrate in polycystic ovarian syndrome patients with insulin resistance. Gynecol Endocrinol. 2015;31(2):131-5.

Raffone E, Rizzo P, Benedetto V. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. Gynecol Endocrinol. 2010;26(4):275-80.

Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocr Connect. 2017; 6(8):647-58.

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.

Tagliaferri V, Romualdi D, Immediata V, De Cicco S, Di Florio C, Lanzone A, et al. Metformin versus myoinositol: which is better in obese polycystic ovary syndrome patients? A randomized controlled crossover study. Clin Endocrinol. 2017;86(5):725-30.