Myo-inositol: therapeutic possibilities and pregravid preparation in women with pcos

Authors

  • Л. В. Калугина SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Ukraine https://orcid.org/0000-0003-2263-6627
  • Т. И. Юско SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”, Ukraine

DOI:

https://doi.org/10.18370/2309-4117.2018.42.40-45

Keywords:

СПКЯ, инсулинорезистентность, лечение, мио-инозитол, бесплодие, прегравидарная подготовка

Abstract

Polycystic ovary syndrome (PCOS) as one of the main causes of ovarian dysfunction in women of reproductive age accounts for more than half of infertility cases of endocrine origin

(50–75%), and increases the risk of miscarriage and such perinatal complications as gestational diabetes, fetal macrosomia, gestational hypertension (preclamation, pregnancy-induced hypertension). Due to metabolic, hormonal disorders, patients with PCOS have an increased risk of anovulatory cycles and constitute the main group of women who resort to the IVF procedure, they also have a 10-fold increased risk of type 2 diabetes and cardiovascular disease, as well as cancer endometrium and breast cancer.

The search for pharmacological substances for pathogenetic therapy of PCOS continues, whereas modern approaches to treatment are mainly aimed at correcting insulin resistance, restoring the menstrual cycle, ovulating, reducing the manifestations of hyperandrogenism, and presenting symptomatic therapy. It is on the correction of metabolic disorders sent recommendations for lifestyle modification, which provide for rational nutrition, metered physical exertion, as well as an additional intake of vitamin-mineral complexes, since PCOS is a neuroendocrinal syndrome that requires constant maintenance therapy.

A systematic analysis of the studies conducted in this study showed that the inclusion of myo-inositol in a 4 g per day to treatment of PCOS reduces the insulin resistance, excessive androgen secretion, the risk of hirsutism and acne, the normalization of the lipid profile and the restoration of fertility. The data obtained make it possible to include myo-inositol in pregravid preparation of patients with PCOS, as well as in the preparations for the IVF procedure, than to significantly improve its result in patients with PCOS and other pathologies associated with infertility. As a myo-inositol-containing preparation for the pregravid preparation of women with PCOS, an innovative complex can be recommend: myo-inositol + 5-methyltetrahydrofolate + vitamin B12, which necessary for the prevention of neural tube defects, hyperhomocysteinemia and miscarriage.

Author Biographies

Л. В. Калугина, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

MD, leading researcher at the Endocrine Gynecology Department

Т. И. Юско, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”

Junior researcher at the Endocrine Gynecology Department

References

  1. Regidor, P.-A., Schindler, A.E. “Mio-inositol as a safe and alternative approach in the treatment of infertility in women with polycystic ovary syndrome: an observational study (Germany).” Gynecology. Women Health 8 (2017).
  2. Genazzani, A.D., Lanzoni, S., Ricchieri, F., Iasonni, V.M. “The introduction of myo-inositol positively affects hyperinsulinemia and hormonal parameters in patients with obesity with polycystic ovary syndrome.” Gynecological Endocrinology 24.3 (2008): 139.
  3. Gromova, O.A., Torshin, I.Y., Limanova, O.A. “Prospects for the use of myo-inositol in women with polycystic ovary and insulin resistance in programs of pregravid preparation for extracorporeal fertilization.” Effective Pharmacotherapy. Obstetrics and gynecology 5.51 (2013).
  4. Kapshuk, І.М., Islamova, G.O. “Features of treatment of polycystic ovary syndrome in women with metabolic syndrome.” Endocrine gynecology 13 (2018).
  5. Saha, L., Kaur, S., Saha, P.K. “Pharmacotherapy of polycystic ovary syndrome: an update.” Fundam Clin Pharmacol 26.1 (2012): 54–62.
  6. Tatarchuk, T.F., Ganzhyi, I.Y., Pedachenko, N.Y., Kapshuk, I.M. “Modern possibilities of non-hormonal treatment of polycystic ovary syndrome in obese women.” Reproductive endocrinology 5.13 (2013): 19–21.
  7. Limanova, O.A., Gromova, O.A., Torshin, I.Y., et al. “Systematic analysis of the molecular-physiological effects of myo-inositol: data from molecular biology, experimental and clinical medicine.” Effective pharmacotherapy. Obstetrics and gynecology 28 Issue 3 (2013): 32–41.
  8. Gromova, O.A., Torshin, I.Y., Grishina, T.R. “Systematic analysis of the molecular-physiological effects of myo-inositol: data from molecular biology, experimental and clinical medicine.” Effective pharmacotherapy 28 (2013): 4–12.
  9. Papaleo, E., Unfer, V., Baillargeon, J.P., et al. “Contribution of myo-inositol to reproduction.” Eur J Obstet Gynecol Reprod Biol 147.2 (2009): 120–3.
  10. Goud, P.T., Goud, A.P., Leybaert, L., et al. “Inositol 1,4,5-trisphosphate receptor function in human oocytes: calcium responses and oocyte activation-related phenomena induced by photolytic release of InsP(3) are blocked by a specific antibody to the type I receptor.” Mol HumReprod 8.10 (2002): 912–8.
  11. Croche, M.L., Soulage, S.O. “Potential role and therapeutic interest of myo-inositol in metabolic diseases.” Biochimie 95.10 (2013): 1811.
  12. Minozzi, M., Nordio, M., Pajalich, R. “The Combined therapy myo-inositol plus D-Chiro-inositol, in a physiological ratio, reduces the cardiovascular risk by improving the lipid profile in PCOS patients.” Eur Rev Med Pharmacol Sci 17.4 (2013): 537–40.
  13. Genazzani, A.D., Prati, A., Santagni, S., et al. “Differential insulin response to myo-inositol administration in obese polycystic ovary syndrome patients.” Gynecol Endocrinol 28.12 (2012): 969–73.
  14. Carlomagno, G., De Grazia, S., Unfer, V. “Myo-inositol in a new pharmaceutical form: a step forward to a broader clinical use.” Expert Opin Drug Deliv 9.3 (2012):267–71.
  15. 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 26.4 (2010): 275–80.
  16. D’Anna, R., Di Benedetto, V., Rizzo P., et al. “Myo-inositol may prevent gestational diabetes in PCOS women.” Gynecol Endocrinol 28.6 (2012): 440–2.
  17. Zacchè, M.M., Caputo, L., Filippis, S., et al. “Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome.” Gynecol Endocrinol 25.8 (2009): 508–13.
  18. Costantino, D., Minozzi, G., Minozzi, E., et al. “Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial.” Eur Rev Med Pharmacol Sci 13.2 (2009): 105–10.
  19. Gerli, S., Papaleo, E., Ferrari, A., et al. “Randomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOS.” Eur Rev Med Pharmacol Sci 11.5 (2007): 347–54.
  20. Artini, P.G., Di Berardino, O.M., Papini F., et al. “Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study.” Gynecol Endocrinol 29.4 (2013): 375–9.
  21. Venturella, R., Mocciaro, R., De Trana, E., et al. “Assessment of the modification of the clinical, endocrinal and metabolical profile of patients with PCOS syndrome treated with myo-inositol.” Minerva Ginecol 64.3 (2012): 239–43.
  22. Unfer, V., Carlomagno, G., Rizzo P., et al. “Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial.” Eur Rev Med Pharmacol Sci 15.4 (2011):452–7.
  23. Chiu, T.T.Y., Rogers, M.S., Law,E.L.K., et al. “Follicular fluid and serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality.” Human Reproduction 17.6 (2002): 1591–6.
  24. Unfer, V., Carlomagno, G., Dante, G., et al. “Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials.” Gynecol Endocrinol 28.7 (2012):509–15.
  25. Papaleo, E., Unfer, V., Baillargeon, J.P., et al. “Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial.” Fertil Steril 91.5 (2009): 1750–4.
  26. Ciotta, L., Stracquadanio, M., Pagano, I., et al. “Effects of myo-inositol supplementation on oocyte’s quality in PCOS patients: a double blind trial.” Eur Rev Med Pharmacol Sci 15.5 (2011): 509–14.
  27. Condorelli, R.A., La Vignera, S., Di Bari, F., et al. “Effects of myo-inositol on sperm mitochondrial function in-vitro.” Eur Rev Med Pharmacol Sci 15.2 (2011): 129–34.
  28. Carlomagno, J., Unfer, V. “Inositol Safety: Clinical Evidence.” European Review of Medical and Pharmacological Studies 15.8 (2011): 931.
  29. Sun, T.H., Heimark, D.B., Nguygen, T., et al. “Both myo-inositol to chiro-inositol epimerase activities and chiro-inositol to myo-inositol ratios are decreased in tissues of GK type 2 diabetic rats compared to Wistar controls.” Biochem Biophys Res Commun 293.3 (2002): 1092–8.
  30. Unfer, V., Carlomagno, G., Papaleo, E., et al. “Hyperinsulinemia Alters Myoinositol to d-chiroinositol Ratio in the Follicular Fluid of Patients With PCOS.” Reprod Sci 21.7 (2014):854–8.
  31. Heimark, D., McAllister, J., Larner, J. “Decreased myo-inositol to chiro-inositol (M/C) ratios and increased M/C epimerase activity in PCOS theca cells demonstrate increased insulin sensitivity compared to controls.” Endocr J 61.2 (2014):111–7.
  32. Nestler, J.E., Unfer, V. “Reflections on inositol(s) for PCOS therapy: steps toward success.” Gynecol Endocrinol 31.7 (2015):501–5.
  33. Nordio, M., Proietti, E. “The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone.” Eur Rev Med Pharmacol Sci 16.5 (2012):575–81.
  34. Rosalbino, I., Raffone, E. “Does ovary need D-chiro-inositol?” Journal of Ovarian Research 5 (2012):14. DOI: 10.1186/1757-2215-5-14
  35. Bevilacqua, A., Carlomagno, G., Gerli, S., et al. “Results from the International Consensus Conference on myo-inositol and D-chiro-inositol inassisted reproduction technology.” Obstetrics and Gynecology 31.6 (2015):441–6.
  36. Papaleo, E., Unfer, V., Baillargeon, J.-P., et al. “Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction.” Gynecol Endocrinol 23 (2007): 700–3.
  37. Rosenquist, T.H., Ratashak, S.A., Selhub, J. “Homocysteine induces congenital defects of the heart and neural tube: effect of folic acid.” Proc Natl Acad Sci 93 (1996): 15227–32.
  38. Thomson, R.L., Buckley, J.D., Brinkworth, G.D. “Exercise for the treatment and management of overweight women with polycystic ovary syndrome: a review of the literature.” Obes Rev 12 (2011): e202-e210.
  39. Le Donne, M., Alibrandi, A., Giarrusso, R., et al. “Diet, metformin and inositol in overweight and obese women with polycystic ovary syndrome: effects on body composition.” Minerva ginecologica 64.1 (2012):23–9.
  40. Zacche, M.M., Caputo, L., Filippis, S., et al. “Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome.” Gynecol Endocrinol 25 (2009): 508–13.
  41. Minozzi, M., D’Andrea, G., Unfer, V. “Treatment of hirsutism with myo-inositol: a prospective clinical study.” Reprod Biomed Online 17 (2008): 579–82.

Published

2018-10-12

How to Cite

Калугина, Л. В., & Юско, Т. И. (2018). Myo-inositol: therapeutic possibilities and pregravid preparation in women with pcos. REPRODUCTIVE ENDOCRINOLOGY, (42), 40–45. https://doi.org/10.18370/2309-4117.2018.42.40-45

Issue

Section

Gynecology