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Lete I, Martínez A, Lasaga I, Centurión E, Vesga A. Update on the combination of myo-inositol/d-chiro-inositol for the treatment of polycystic ovary syndrome. Gynecol Endocrinol 2024; 40:2301554. [PMID: 38239032 DOI: 10.1080/09513590.2023.2301554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
In this article, we present a narrative review on the use of inositol in the treatment of polycystic ovary syndrome (PCOS). Of the different inositols that exist, only myo-inositol (MYO) and D-chiro inositol (DCI) have been studied in the treatment of PCOS. The results of the studies show that there is insufficient or controversial evidence to recommend the use of DCI alone, while MYO alone shows positive results and, above all, the MYO/DCI combination is effective when used at a ratio of at least 40:1, but there is enough rationale to further study ratios such as 66:1 to 100:1 as other possible effective combinations.
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Affiliation(s)
- Iñaki Lete
- Obstetrics and Gynaecology Clinical Management Unit, Araba University Hospital, Vitoria, Spain
| | - Ainara Martínez
- Obstetrics and Gynaecology Clinical Management Unit, Araba University Hospital, Vitoria, Spain
| | - Irene Lasaga
- Obstetrics and Gynaecology Clinical Management Unit, Araba University Hospital, Vitoria, Spain
| | - Eva Centurión
- Obstetrics and Gynaecology Clinical Management Unit, Araba University Hospital, Vitoria, Spain
| | - Amaia Vesga
- Obstetrics and Gynaecology Clinical Management Unit, Araba University Hospital, Vitoria, Spain
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2
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Katyal G, Kaur G, Ashraf H, Bodapati A, Hanif A, Okafor DK, Khan S. Systematic Review of the roles of Inositol and Vitamin D in improving fertility among patients with Polycystic Ovary Syndrome. Clin Exp Reprod Med 2024; 51:181-191. [PMID: 38599886 DOI: 10.5653/cerm.2023.06485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/20/2023] [Indexed: 04/12/2024] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder among reproductive-age women. As a leading cause of anovulatory infertility, it complicates fertility treatments, including in vitro fertilization. The widely accepted 2003 Rotterdam diagnostic criteria for PCOS include sub-phenotypes based on variations in androgen excess, ovulatory dysfunction, and polycystic ovarian morphology. In this systematic review, we examined the impacts of inositol and vitamin D on fertility in PCOS. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we used relevant keywords to comprehensively search databases including PubMed, Google Scholar, and MDPI. From an initial pool of 345 articles, 10 met the inclusion criteria. The articles suggest that vitamin D and inositol, particularly myo-inositol and D-chiro-inositol, may represent therapeutic options for PCOS. Vitamin D influences ovarian follicular development, glucose regulation, and insulin sensitivity. When combined with metformin therapy, it is associated with improved menstrual regularity and ovulation. Inositol is crucial for cellular signaling, energy metabolism, glucose regulation, and fertility. This systematic review underscores the importance of investigating inositol and vitamin D within a PCOS management strategy, given the disorder's prevalence and impacts on fertility and metabolic health. Although these agents show promise, additional research could clarify their mechanisms of action and therapeutic benefits. This review emphasizes the need for exploration of effective treatments to improve the quality of life among individuals with PCOS. Inositol and vitamin D represent potential options, but more studies are required to elucidate their roles in the management of this condition.
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Affiliation(s)
- Gitika Katyal
- California Institute of Behavioral Neurosciences and Psychology, Fairfield, CA, USA
| | - Gursharan Kaur
- California Institute of Behavioral Neurosciences and Psychology, Fairfield, CA, USA
| | - Hafsa Ashraf
- California Institute of Behavioral Neurosciences and Psychology, Fairfield, CA, USA
| | - Adiprasad Bodapati
- California Institute of Behavioral Neurosciences and Psychology, Fairfield, CA, USA
| | - Ayesha Hanif
- California Institute of Behavioral Neurosciences and Psychology, Fairfield, CA, USA
| | - Donatus Kaine Okafor
- California Institute of Behavioral Neurosciences and Psychology, Fairfield, CA, USA
| | - Safeera Khan
- California Institute of Behavioral Neurosciences and Psychology, Fairfield, CA, USA
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Armijo-Sánchez A, Benítez Castillo N, García-Vidal E, Luna Chadid M, Salvador Ballada C, Valls Ricart G, Torres Pellens V. Treatment With a Patented 3.6:1 Myo-Inositol to D-chiro-Inositol Ratio, Antioxidants, Vitamins and Minerals Food Supplement in Women With a History of Assisted Reproductive Technique (ART) Failures: A Series of Case Reports. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241242265. [PMID: 38559382 PMCID: PMC10981332 DOI: 10.1177/11795476241242265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
Infertility affects 15% of couples in reproductive age worldwide. In women in particular, infertility can be caused by various abnormalities, with polycystic ovary syndrome (PCOS) being the most common. Currently, there are many assisted reproductive techniques (ART) available to combat the burden of infertility. However, positive results are not guaranteed. The administration of inositol has been shown to increase positive reproductive outcomes in women undergoing ART. Here we present a series of clinical cases in which women with a history of infertility and previously failed ART, supplemented with a specific 3.6:1 MYO:DCI ratio, antioxidants, vitamins, and minerals for a period of 1 to 3 months before undergoing in vitro fertilization (IVF). In this series of case reports, we provide preliminary evidence that supplementation with a specific 3.6:1 MYO to DCI ratio, as well as antioxidants, vitamins, and minerals may contribute positively to female fertility in women undergoing IVF, with a history of primary or secondary infertility and previously failed ART.
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Affiliation(s)
| | - N. Benítez Castillo
- Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain
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KIANI AYSHAKARIM, DONATO KEVIN, DHULI KRISTJANA, STUPPIA LIBORIO, BERTELLI MATTEO. Dietary supplements for polycystic ovary syndrome. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E206-E213. [PMID: 36479481 PMCID: PMC9710389 DOI: 10.15167/2421-4248/jpmh2022.63.2s3.2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most prevalent female endocrine reproductive disorders, affecting between 4 to 18% of the women in their reproductive age. It is generally characterized by several clinical aspects, among which anovulation, inflammation and infertility. Moreover, PCOS has several health implications, including increased metabolic, reproductive, and psychological risks. Previously, metformin and to some extent thiazolidinediones were considered as drug of choice for PCOS management, but they had several side-effects, and controversial results were obtained about their efficiency, especially in non-insulin-resistant non-obese patients. Thus, alternative treatment options are now being studied for PCOS, including different natural molecules and complementary medicines (CM) for the improvement of their health, wellbeing and fertility. Recently, treatment of PCOS patients with different natural molecules, coming from nutritional supplements and herbal medicines, has attained satisfactory results with the absence of any side effects. In this review, four natural molecules, curcumin, vitamin D, inositol and CoQ10 are discussed for their therapeutic ability. These molecules proved to decrease insulin sensitivity and inflammation, to improve the restoration of ovarian function, and they could restore hormonal balance and regulate the menstrual cycle, all of which are the main features and major concerns for women suffering from PCOS.
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Affiliation(s)
| | - KEVIN DONATO
- MAGI Euregio, Bolzano, Italy
- Correspondence: Kevin Donato, MAGI Euregio, Via Maso della Pieve 60/A, 39100 Bolzano, Italy. E-mail:
| | | | - LIBORIO STUPPIA
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio” University, Chieti, Italy
| | - MATTEO BERTELLI
- MAGI Euregio, Bolzano, Italy
- MAGI’s Lab, Rovereto, Italy
- MAGISNAT, Peachtree Corners, USA
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Mendoza N, Losa F, Palacios S. Strategy to improve the female fertility in the general gynecologist's office: use of a nutritional supplement based on myo-inositol/D-chiro-inositol and antioxidants. Gynecol Endocrinol 2022; 38:275-278. [PMID: 34931570 DOI: 10.1080/09513590.2021.2015759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Subfertility is more than a quality-of-life problem as it has a substantial negative public health impact. Polycystic ovary syndrome (PCOS) is one of the most common causes of subfertility, affecting one out of 10 women in reproductive age. Among PCOS women undergoing assisted reproductive technology, treatment based on myo-inositol and high doses of D-chiro-inositol has been shown to increase pregnancy rate and number of live births, reduce ovarian hyperstimulation syndrome and improve oocyte quality. A preparation based on myo-inositol and high doses of D-chiro-inositol, together with antioxidants, vitamins, and minerals, could have beneficial effects and be an optimal strategy to improve female fertility in the general gynecologist's office. The aim of this review is to highlight the role of inositol and its isomers in improving fertility of women with PCOS.
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Affiliation(s)
- Nicolás Mendoza
- Director del Departamento de Obstetricia y Ginecología, Universidad de Granada, Granada, España, Spain
| | - Fernando Losa
- Servicio de Ginecología, Clínica Sagrada Familia, Barcelona de Barcelona, Spain
| | - Santiago Palacios
- Director del Instituto Palacios de Salud y Medicina de la Mujer, Madrid, España, Spain
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Cianci A, Vitale SG. D-Chiro-inositol and PCOS: between myth and reality. The never-ending story. Int J Food Sci Nutr 2022; 73:565-570. [DOI: 10.1080/09637486.2022.2029830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Antonio Cianci
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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Merviel P, James P, Bouée S, Le Guillou M, Rince C, Nachtergaele C, Kerlan V. Impact of myo-inositol treatment in women with polycystic ovary syndrome in assisted reproductive technologies. Reprod Health 2021; 18:13. [PMID: 33468143 PMCID: PMC7816413 DOI: 10.1186/s12978-021-01073-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/05/2021] [Indexed: 02/02/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is marked in 30 to 40% by insulin resistance and hyperandrogenism. Myo-inositol (MI) increases insulin sensitivity, decreases hyperandrogenism and improves the menstrual cycle. Its effect during assisted reproductive technologies (ART) has been studied by many authors. We conducted a review of the literature on the impact of MI administration in PCOS women in assisted reproductive technologies. Myo-inositol is effective in normalizing ovarian function, improving oocyte and embryo quality in PCOS, however further evaluations by large multicentre randomized controlled trials are needed to assess the clinical pregnancy and live birth rates in ART.
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Affiliation(s)
- Philippe Merviel
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France.
| | - Pandora James
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Sarah Bouée
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Mathilde Le Guillou
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Camille Rince
- Fertility and ART Department, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France
| | - Charlotte Nachtergaele
- Endocrinology and Metabolism Department, Brest University Hospital, Boulevard Tanguy Prigent, 29200, Brest, France
| | - Véronique Kerlan
- Endocrinology and Metabolism Department, Brest University Hospital, Boulevard Tanguy Prigent, 29200, Brest, France
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Abstract
(1) Background: Myoinositol (MI) and D-chiro-inositol (DCI) are involved in a number of biochemical pathways within oocytes having a role in oocyte maturation, fertilization, implantation, and post-implantation development. Both inositols have a role in insulin signaling and hormonal synthesis in the ovaries. (2) Methods: Literature search (with key words: inositols, myo-inositol, d-chiro-inositol, PCOS) was done in PubMed until Sept. 2020 and 197 articles were identified, of which 47 were of clinical trials (35 randomized controlled trials). (3) Results: Many studies have demonstrated that in patients with polycystic ovarian syndrome (PCOS) MI treatment improved ovarian function and fertility, decreased the severity of hyperandrogenism including acne and hirsutism, positively affected metabolic aspects, and modulated various hormonal parameters deeply involved in the reproductive axis function and ovulation. Thus treating with MI has become a novel method to ameliorate PCOS symptoms, improve spontaneous ovulation, or induce ovulation. The current review is focused on the effects of MI and DCI alone or in combination with other agents on the pathological features of PCOS with focus on insulin resistance and adverse metabolic outcomes. (4) Conclusions: The available clinical data suggest that MI, DCI, and their combination in physiological ratio 40:1 with or without other compound could be beneficial for improving metabolic, hormonal, and reproductive aspects of PCOS.
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Affiliation(s)
- Zdravko Kamenov
- Department of Internal Medicine, Clinic of Endocrinology University Hospital Alexandrovska, Medical University—Sofia, 1431 Sofia, Bulgaria;
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Artini PG, Obino MER, Micelli E, Malacarne E, Vacca C, Papini F, Cela V. Effect of d-chiro-inositol and alpha-lipoic acid combination on COH outcomes in overweight/obese PCOS women. Gynecol Endocrinol 2020; 36:755-759. [PMID: 32157927 DOI: 10.1080/09513590.2020.1737007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Insulin resistance (IR) plays a central role in the onset of polycystic ovary syndrome (PCOS). Insulin so insulin-sensitizing like inositols have been proposed as first line therapy. Among them d-chiro-inositol (DCI) seems to improve glucose metabolism and to increase ovulation frequency. Other studies have demonstrated that alpha-lipoic acid (ALA), with its antioxidant role, can also improve endocrine and metabolic profile of PCOS patients especially with familial diabetes. This a retrospective observational study with the aim to evaluate possible advantages of an integrative preparation combining DCI 500 mg and ALA 300 mg in overweight/obese PCOS patients with or without diabetic relatives who underwent IVF. Twenty PCOS patients who were taking the integrative preparation underwent controlled ovarian hyperstimulation in our center. The group with diabetic relatives tended to have a lower dose of gonadotropin, shorter stimulation days, higher number of MII oocytes, and higher number of fertilized oocytes. A combined regimen of DCI and ALA could be an interesting strategy in overweight PCOS patients with familial diabetes underwent ART.
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Affiliation(s)
- Paolo Giovanni Artini
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Maria Elena Rosa Obino
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Elisabetta Micelli
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Elisa Malacarne
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Chiara Vacca
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Francesca Papini
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Vito Cela
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
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Pericuesta E, Laguna-Barraza R, Ramos-Ibeas P, Gutierrez-Arroyo JL, Navarro JA, Vera K, Sanjuan C, Baixeras E, de Fonseca FR, Gutierrez-Adan A. D-Chiro-Inositol Treatment Affects Oocyte and Embryo Quality and Improves Glucose Intolerance in Both Aged Mice and Mouse Models of Polycystic Ovarian Syndrome. Int J Mol Sci 2020; 21:E6049. [PMID: 32842637 PMCID: PMC7504697 DOI: 10.3390/ijms21176049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
Polycystic ovarian syndrome (PCOS) is the main cause of female infertility. It is a multifactorial disorder with varying clinical manifestations including metabolic/endocrine abnormalities, hyperandrogenism, and ovarian cysts, among other conditions. D-Chiro-inositol (DCI) is the main treatment available for PCOS in humans. To address some of the mechanisms of this complex disorder and its treatment, this study examines the effect of DCI on reproduction during the development of different PCOS-associated phenotypes in aged females and two mouse models of PCOS. Aged females (8 months old) were treated or not (control) with DCI for 2 months. PCOS models were generated by treatment with dihydrotestosterone (DHT) on Days 16, 17, and 18 of gestation, or by testosterone propionate (TP) treatment on the first day of life. At two months of age, PCOS mice were treated with DCI for 2 months and their reproductive parameters analyzed. No effects of DCI treatment were produced on body weight or ovary/body weight ratio. However, treatment reduced the number of follicles with an atretic cyst-like appearance and improved embryo development in the PCOS models, and also increased implantation rates in both aged and PCOS mice. DCI modified the expression of genes related to oocyte quality, oxidative stress, and luteal sufficiency in cumulus-oocyte complexes (COCs) obtained from the aged and PCOS models. Further, the phosphorylation of AKT, a main metabolic sensor activated by insulin in the liver, was enhanced only in the DHT group, which was the only PCOS model showing glucose intolerance and AKT dephosphorylation. The effect of DCI in the TP model seemed mediated by its influence on oxidative stress and follicle insufficiency. Our results indicate that DCI works in preclinical models of PCOS and offer insight into its mechanism of action when used to treat this infertility-associated syndrome.
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Affiliation(s)
- Eva Pericuesta
- Departamento de Reproducción Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), 28040 Madrid, Spain; (E.P.); (R.L.-B.); (P.R.-I.); (J.L.G.-A.)
| | - Ricardo Laguna-Barraza
- Departamento de Reproducción Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), 28040 Madrid, Spain; (E.P.); (R.L.-B.); (P.R.-I.); (J.L.G.-A.)
| | - Priscila Ramos-Ibeas
- Departamento de Reproducción Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), 28040 Madrid, Spain; (E.P.); (R.L.-B.); (P.R.-I.); (J.L.G.-A.)
| | - Julia L. Gutierrez-Arroyo
- Departamento de Reproducción Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), 28040 Madrid, Spain; (E.P.); (R.L.-B.); (P.R.-I.); (J.L.G.-A.)
| | - Juan A. Navarro
- Laboratorio de Neuropsicofarmacología, Unidad de Gestión Clínica de Salud Mental, Instituto IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (K.V.); (F.R.d.F.)
| | - Katia Vera
- Laboratorio de Neuropsicofarmacología, Unidad de Gestión Clínica de Salud Mental, Instituto IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (K.V.); (F.R.d.F.)
| | - Carlos Sanjuan
- Euronutra S.L., Calle Johannes Kepler 3, 29590 Málaga, Spain;
| | - Elena Baixeras
- Departamento de Bioquímica y Biología Molecular, Facultad de Medicina, Universidad de Málaga, 29010 Málaga, Spain;
| | - Fernando Rodríguez de Fonseca
- Laboratorio de Neuropsicofarmacología, Unidad de Gestión Clínica de Salud Mental, Instituto IBIMA, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (J.A.N.); (K.V.); (F.R.d.F.)
| | - Alfonso Gutierrez-Adan
- Departamento de Reproducción Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), 28040 Madrid, Spain; (E.P.); (R.L.-B.); (P.R.-I.); (J.L.G.-A.)
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Roseff S, Montenegro M. Inositol Treatment for PCOS Should Be Science-Based and Not Arbitrary. Int J Endocrinol 2020; 2020:6461254. [PMID: 32308679 PMCID: PMC7140126 DOI: 10.1155/2020/6461254] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/03/2020] [Indexed: 02/02/2023] Open
Abstract
The aim of this paper is to critically analyze the composition of many inositol-based products currently used to treat Polycystic Ovary Syndrome (PCOS). Several different combinations of myo-inositol and D-chiro-inositol, with and without additional compounds such as micro- and macroelements, vitamins, and alpha-lipoic acid, have been formulated over the years. Such therapeutic proposals do not take various features of inositol stereoisomers into consideration. As an example, it is important to know that D-chiro-inositol treatment may be beneficial when administered in low doses, yet the progressive increase of its dosage results in the loss of its advantageous effects on the reproductive performance of women and a deterioration in the quality of blastocysts created via in vitro fertilization (IVF). In addition, we have to consider that the intestinal absorption of myo-inositol is reduced by the simultaneous administration of D-chiro-inositol since the two stereoisomers compete with each other for the same transporter that has similar affinity for each of them. A decrease in myo-inositol absorption is also found when it is coadministered with inhibitors of sugar intestinal absorption and/or types of sugars such as sorbitol, maltodextrin, and sucralose. The combination of these may require higher amounts of myo-inositol in order to reach a therapeutic dosage compared to inositol administration alone, a particularly important fact when physicians strive to obtain a specific plasma level of the stereoisomer. Finally, we must point out that D-chiro-inositol was found to be an aromatase inhibitor which increases androgens and may have harmful consequences for women. Therefore, the inositol supplements used in PCOS treatment must be carefully defined. Clinical evidence has demonstrated that the 40 : 1 ratio between myo-inositol and D-chiro-inositol is the optimal combination to restore ovulation in PCOS women. Therefore, it is quite surprising to find that inositol-based treatments for PCOS seem to be randomly chosen and are often combined with useless or even counterproductive molecules, all of which can weaken myo-inositol's efficacy. Such treatments clearly lack therapeutic rationale.
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Affiliation(s)
- Scott Roseff
- South Florida Institute for Reproductive Medicine, Boca Raton, FL 33428, USA
| | - Marta Montenegro
- South Florida Institute for Reproductive Medicine, Miami, FL 33143, USA
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