Thursday 24 February 2011
Myo-inositol is a unique vitamin B-like substance that has become highly regarded as a novel way to help women with PCOS to conceive. It can also help to reduce miscarriage risks and to minimize the risks of severe ovarian hyper-stimulation syndrome (OHSS) in IVF/ART.
Thirty to forty percent of PCOS women have irregularities in their glucose / insulin control mechanisms which is where Myo-inositol works it's magic. Inositol is integral to properly functioning insulin-receptors and providing extra inositol seems to profoundly improve insulin levels and reduce the associated high androgen levels (testosterone and DHEA) without side-effects or toxicity.
Women with PCOS are known to have a defect in their insulin-signaling pathways which are heavily dependent upon inositol-containing substances (phosphoglycan mediators). Supplying extra myo-inositol appears to temporarily correct the mal-functioning insulin pathways and reduce the signs and symptoms of insulin resistance.
Interestingly, inositol has been used in other studies for panic disorders and can have a profoundly calming effect upon the nervous system. Also studies show (6) that high levels of myo-inositol within follicles may be a marker for good follicular development and good oocyte or egg quality.
As there seems to be some confusion regarding exactly how to use Myo-Inositol - and how it can be used alongside IVF/ART - here is a brief overview of the studies to date that can help you to understand Myo-inositol's unique value to PCOS women.
In an Italian study in 2007 (1) researchers followed 25 women with oligo-amenorrhea (irregular menses) or amenorrhea (no menses) due to PCOS. Myo-inositol and folic acid were given daily as 'Inofolic' 2g twice a day for 6 months. Eighty eight percent of the women who were treated had at least one menstrual cycle, and of these, seventy two percent continued ovulating normally. Forty percent of the women became pregnant and the study concluded that:
"Myo-inositol is a simple and safe treatment that is capable of restoring spontaneous ovarian activity and consequently fertility in most patients with PCOS. This therapy did not cause multiple pregnancy."
Another Italian study (2) in 2010 compared the effects of Myo-inositol or metformin in PCOS women and then compared these two treatments with the addition of gonadotrophin (r-FSH) for ovulation induction. One hundred and twenty patients took either 1500 mg/day of metformin or a combination of folic acid 400 mcg and Myo-inositol 4 g per day.
In the women that did not conceive a low dose of FSH (37.5 units/day) was added for up to three cycles. Of the women taking just metformin, fifty percent resumed ovulation and eighteen percent became pregnant. FSH treatment was administered to the 'metformin-only' women who did not conceive and a further twenty six percent conceived producing a total pregnancy rate of 36.6%.
Of the women taking myo-inositol and folic acid, sixty-five percent resumed ovulation and thirty percent conceived. FSH was administered to the myo-inositol women who did not conceive and a further twenty nine percent conceived producing a total pregnancy rate of 48.4%.
This study - which showed that myo-iositol can out-perform metformin - concluded that:
"Both metformin and MYO, can be considered as first line treatment for restoring normal menstrual cycles in most patients with PCOS, even if MYO treatment seems to be more effective than metformin."
In yet another Italian study (3) in 2009, Myo-inositol (MYO) was studied as a novel solution to symptoms of PCOS such as hirsutism (excess body hair), acne and hair loss. Fifty PCOS women were give Myo-inositol for six months and after only three months levels of LH, testosterone and free testosterone and insulin were significantly reduced. At the end of the six months hirsutism and acne had decreased also and the study concluded that:
"MYO administration is a simple and safe treatment that ameliorates the metabolic profile of patients with PCOS, reducing hirsutism and acne."
Back to Italy again, in 2008 Myo-inositol was studied (5) specifically with PCOS women who were overweight. Twenty overweight women with PCOS were treated and after 12 weeks of myo-inositol demonstrated that levels of LH, prolactin, testosterone, insulin, LH/FSH, insulin sensitivity and glucose-to-insulin ratios could change significantly. Menstrual cycles were restored in all the patients with irregular or no menstruation. The study concluded that:
"Myo-inositol administration improves reproductive axis functioning in PCOS patients reducing the hyperinsulinemic state that affects LH secretion."
Lastly, a randomized double-blind trial (7) - the gold standard of research - gave 92 women either 400 mcg of folic acid as a placebo or 4 g myo-inositol plus 400 mcg folic acid as the treatment arm. They discovered likewise that ovulation significantly increased as did the frequency of normal progesterone values in the luteal phase and estradiol levels in the myo-inositol group.
This study noted less metabolic benefits to those women who were overweight but also that the myo-inositol group lost a significant amount of weight and had lowered leptin levels. The study concluded that:
"These data support a beneficial effect of myo-inositol in women with oligomenorrhea and polycystic ovaries in improving ovarian function."
(1) Gynecol Endocrinol 2007 Dec;23(12):700-3. Epub 2007 Oct 10. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Papaleo E, et al.
(2) Gynecol Endocrinol 2010 Apr;26(4):275-80. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. Raffone E, et al.
(3) Gynecol Endocrinol 2009 Aug;25(8):508-13. Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome. Zacche MM, et al.
(4) 2008 Mar;24(3):139-44. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Genazzani AD, et al.
Eur J Obstet Gynecol Reprod Biol 2009 Dec;147(2):120-3. Epub 2009 Oct 2.
Contribution of myo-inositol to reproduction. Papaleo E et al. Eur Rev Med Pharmacol Sci 2007 Sep-Oct;11(5):347-54.
Randomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOS. Gerli S, et al. European Review for Medical and Pharmacological Sciences 2007; 11: 347-354