Impact of inositols on ovarian reserve markers

  • Bhide P & al.
  • Acta Obstet Gynecol Scand
  • 16 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis provides insufficient evidence for inositols to change ovarian reserve markers and to support their use in women with polycystic ovary syndrome (PCOS) as pre-treatment before in-vitro fertilisation (IVF)/intra-cytoplasmic sperm injection (ICSI).

Why this matters

  • Inositols have been reported to alter folliculogenesis and the functional ovarian reserve, with benefits to reproductive outcomes after IVF/ICSI treatment.
  • However, published literature is not able to provide definitive evidence of its efficacy.

Study design

  • Meta-analysis of 18 trials involving women with PCOS.
  • Primary outcome: change in anti-Mullerian hormone (AMH) and antral follicle count (AFC).
  • Secondary outcome: number of retrieved oocytes, number of mature (metaphase II) oocytes, number of top-grade embryos, pregnancy rate, live birth rate and risk for ovarian hyperstimulation syndrome (OHSS).
  • Funding: None.

Key results

  • Data for primary outcome were unsuitable for meta-analysis with unreliable direction or size of effect for a change in AMH or AFC after treatment with myo-inositol and di-chiro-inositol.
  • No significant difference was found for secondary outcomes between inositol and control groups for any outcome:
    • number of oocytes (mean difference [MD], −0.39; 95% CI, −1.11 to 0.33),
    • number of metaphase II oocytes (MD, 0.29; 95% CI, −0.83 to 1.40),
    • number of top-grade embryos (risk ratio [RR], 1.02; 95% CI, 0.93-1.12),
    • clinical pregnancy rate (RR, 1.16; 95% CI, 0.87-1.53), and
    • risk of OHSS (RR, 0.73; 95% CI, 0.39-1.37).

Limitations

  • High heterogeneity of the study.
  • Variation in dose and duration of inositol.

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