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Cited by 115Ovarian function and disordersReproductive Biology and FertilityReproductive Health and Technologies

Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta‐analysis of randomised trials

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Pundir, J, Psaroudakis, D, Savnur, P, Bhide, P, Sabatini, L, Teede, H, Coomarasamy, A, Thangaratinam, S·2018·BJOG: An International Journal of Obstetrics & Gynaecology
DOI 10.1111/1471-0528.14754
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Abstract

Polycystic ovary syndrome is a common cause of anovulation and infertility, and a risk factor for development of metabolic syndrome and endometrial cancer. Systematic review and meta‐analysis of randomised controlled trials (RCT) that evaluated the effects of inositol as an ovulation induction agent. We searched MEDLINE, EMBASE, Cochrane and ISI conference proceedings, Register and Meta‐register for RCT and WHO trials’ search portal. We included studies that compared inositol with placebo or other ovulation induction agents. Quality of studies was assessed for risk of bias. Results were pooled using random effects meta‐analysis and findings were reported as relative risk or standardised mean differences. We included ten randomised trials. A total of 362 women were on inositol (257 on myo‐inositol; 105 on di‐chiro‐inositol), 179 were on placebo and 60 were on metformin. Inositol was associated with significantly improved ovulation rate (RR 2.3; 95% CI 1.1–4.7; I2 = 75%) and increased frequency of menstrual cycles (RR 6.8; 95% CI 2.8–16.6; I2 = 0%) compared with placebo. One study reported on clinical pregnancy rate with inositol compared with placebo (RR 3.3; 95% CI 0.4–27.1), and one study compared with metformin (RR 1.5; 95% CI 0.7–3.1). No studies evaluated live birth and miscarriage rates. Inositol appears to regulate menstrual cycles, improve ovulation and induce metabolic changes in polycystic ovary syndrome; however, evidence is lacking for pregnancy, miscarriage or live birth. A further, well‐designed multicentre trial to address this issue to provide robust evidence of benefit is warranted. Tweetable abstract: Inositols improve menstrual cycles, ovulation and metabolic changes in polycystic ovary syndrome

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Crossref · 10.1111/1471-0528.14754

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  • Inositols positively influence menstrual cycle regularity, carbohydrate metabolism, and clinical and laboratory symptoms of hyperandrogenism.

    “They positively influence menstrual cycle regularity, carbohydrate metabolism, and the clinical and laboratory symptoms of hyperandrogenism (e.g., free testosterone, total testosterone, SHBG) [19].”

    From Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials (2023) · cites this paper as [19]

    The Main Findings (p. 11) report more frequent menstrual cycles, improved glycaemic parameters, and improved androgen-related laboratory measures in women with PCOS. The hormonal-profile results (p. 10) show significant changes in total testosterone and SHBG, but not free testosterone (p = 0.06). Our copy does not report improvement in clinical symptoms of hyperandrogenism, so that part of the claim is unsupported. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • The combined analysis of different inositols did not reach the level of significance for DHEAS.

    “However, the combined analysis of different inositols did not reach the level of significance.”

    From Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials (2023) · cites this paper as [19]

    The Effects of inositol on hormonal profile (p. 10) reports a significant decrease in serum DHEA (p = 0.02), but does not report a result for DHEAS, which is a distinct measure. A search for DHEAS and dehydroepiandrosterone sulfate found no passage establishing whether the combined analysis was significant for DHEAS. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

  • Three reviews including 62 trials with 5072 women with PCOS evaluated the efficacy of inositol in PCOS; endocrine outcomes were assessed by all the reviews with benefits reported in testosterone, DHEA, or androstenedione levels.

    “Three reviews including a total of 62 trials with 5072 women with PCOS evaluated the efficacy of inositol in PCOS [47, 85, 86]. Endocrine outcomes were assessed by all the reviews with benefits reported in testosterone, dehydroepiandrosterone (DHEA), or androstenedione levels.”

    From From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management (2020) · cites this paper as [85]

  • Metabolic outcomes were assessed by all the reviews with important results: reduced insulin levels, reduced glucose levels and HOMA-IR, and improved blood pressure, triglycerides, and high-density lipoprotein.

    “Metabolic outcomes were assessed by all the reviews with important results: reduced insulin levels [47, 72, 85], reduced glucose levels and HOMA-IR, and improved blood pressure, triglycerides, and high-density lipoprotein [86].”

    From From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management (2020) · cites this paper as [85]

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Cites

2 retracted

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Research works printed but not linked: 4

  1. [5]5. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E et al., American association of clinical endocrinologists, American college of endocrinology, and Androgen excess and pcos society disease state clinical review:
  2. [2]2. Guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 2. Endocr Pract. 2015 Dec;21(12):1415-26
  3. [31]31. Nestler JE, Jakubowicz DJ, Reamer P, Gunn RD, Allan G. Ovulatory and metabolic effects of Dchiro-inositol in the polycystic ovary syndrome. N Engl J Med. 1999 Apr 29;340(17):1314-20.
  4. [9]9. J Fam Plann Reprod Health Care. 2009 Jul;35(3):181-5.

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Authors
Pundir, J., Psaroudakis, D., Savnur, P., Bhide, P., Sabatini, L., Teede, H., Coomarasamy, A., & Thangaratinam, S.
Affiliations
  • St Bartholomew's Hospital (GB)
  • Queen Mary University of London (GB)
  • Monash University (AU)
  • University of Birmingham (GB)
Corresponding author
Pundir, J
ORCID
Venue
BJOG: An International Journal of Obstetrics & Gynaecology
Publisher
Wiley
Published
2017-07-14
Volume
125
Issue
3
Pages
299-308
ISSN
  • 0306-5456 (ISSN-L)
  • 1470-0328
  • 1471-0528
DOI
10.1111/1471-0528.14754
OpenAlex
W2619835212
Cited by
115
References
46
Citations by year
2026: 8 · 2025: 10 · 2024: 3 · 2023: 16 · 2022: 14 · 2021: 16 · 2020: 19 · 2019: 9 · 2018: 16 · 2017: 4
FWCI
2.14
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (publishedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
Keywords
myo-inositol, polycystic ovary syndrome, anovulation, ovulation induction, metformin, menstrual cycle regularity, ovulation rate, infertility, clinical pregnancy
MeSH terms
Anovulation, Female, Humans, Infertility, Inositol, Polycystic Ovary Syndrome, Vitamin B Complex, Randomized Controlled Trials as Topic

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