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

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

Л. В. Калугина, Т. И. Юско

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.


Keywords


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

References


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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.

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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.

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.

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.

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.

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.

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.

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.

Carlomagno, J., Unfer, V. “Inositol Safety: Clinical Evidence.” European Review of Medical and Pharmacological Studies 15.8 (2011): 931.

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.

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.

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.

Nestler, J.E., Unfer, V. “Reflections on inositol(s) for PCOS therapy: steps toward success.” Gynecol Endocrinol 31.7 (2015):501–5.

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.

Rosalbino, I., Raffone, E. “Does ovary need D-chiro-inositol?” Journal of Ovarian Research 5 (2012):14. DOI: 10.1186/1757-2215-5-14

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.

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.

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.

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.

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.

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.

Minozzi, M., D’Andrea, G., Unfer, V. “Treatment of hirsutism with myo-inositol: a prospective clinical study.” Reprod Biomed Online 17 (2008): 579–82.


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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.

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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.





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