PCOSense

Polycystic ovarian syndrome (PCOS) is one of the most common metabolic and hormonal disorders, affecting one in ten women of reproductive age. (1) Women with PCOS present with a variety of symptoms associated with menstrual dysfunction and androgen excess, including irregular menstrual cycles, weight gain, infertility, and insulin resistance. (1,2)

Insulin resistance affects 30–40% of women with PCOS and is believed to play a key role in abnormal ovarian function. Multiple clinical trials support supplementation with myo-inositol and D-chiro-inositol to help with the hormonal and metabolic symptoms of PCOS by promoting healthy glucose metabolism and reducing insulin resistance. (1–6)

In a placebo-controlled, double-blind clinical trial, women with PCOS were supplemented with 4 g of myo-inositol plus 400 mcg of folic acid daily. After 16 weeks, women taking myo-inositol experienced an 84% increase in whole body insulin sensitivity, compared to no change in the placebo group. Myo-inositol was also shown to improve glucose tolerance and reduce serum total testosterone and serum-free testosterone concentrations by 66% and 73% respectfully. In addition, 69.5% of these women ovulated, compared to 21% taking the placebo). (1)

In a 12-week clinical study, overweight PCOS patients were supplemented with 500 mg of D-chiro-inositol daily. Patients experienced significant improvements in insulin sensitivity, especially those with a family history of diabetes. Hormonal patterns also improved and patient body mass index (BMI) decreased. (2)

Both myo-inositol and D-chiro-inositol have been clinically shown to support a normal menstrual cycle and ovulation in women with PCOS. (3,6) In another double-blind, placebo-controlled trial, PCOS patients were supplemented with 4 g of myo-inositol plus 400 mcg of folic acid daily. Over the 14-week study, parameters of ovarian function improved, including a 25% increase in ovulation frequency (versus a 15% increase in the placebo group) and a significantly shorter time to first ovulation (24.5 days versus 40.4 days for the placebo group). (3)

D-chiro-inositol was shown to help regulate the menstrual cycle in 62.5% of women with PCOS and chronic ovulatory dysfunction when taken for at least four months at a dose of 1 g per day plus 400 mcg of folic acid. The prospective cohort study also found that D-chiro inositol helped lower testosterone and luteinizing hormone levels, as well as other metabolic parameters related to PCOS. (6)

PCOS is the most-common cause of infertility due to anovulation (lack of ovulation). A meta-analysis of seven trials found that supplementation with 4 g of myo-inositol plus 400 mcg of folic acid daily increased pregnancy rates among infertile women undergoing treatments to induce ovulation, such as in vitro fertilization (IVF). Supplementation also allowed for the reduction of ovulation medication needed to promote fertility. (7) In addition, a clinical study supplementing 1.1 g of myoinositol plus 27.6 mg of D-chiro-inositol daily helped improve oocyte and embryo quality, as well as pregnancy rates in women with PCOS undergoing IVF. (8)

Active folate (L-5-MTHF) and methylcobalamin (vitamin B12) support fertility and normal early fetal development, help form red blood cells, and are factors in the maintenance of good health. (9,10) Clinical studies show that folate supplementation at least three months before conception and during early pregnancy reduces the risk of neural tube birth defects by 42–87%. (9)

Studies:

1. Costantino, D., Minozzi, G., Minozzi, E., et al. (2009). Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. European Review for Medical and Pharmacological Sciences, 13(2), 105-110.

2. Genazzani, A.D., Santagni, S., Rattighieri, E., et al. (2014). Modulatory role of D-chiro-inositol (DCI) on LH and insulin secretion in overweight PCOS patients. Gynecological Endocrinology, 30(6), 438-443.

3. Gerli, S., Papaleo, E., Ferrari, A., et al. (2007). Randomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOS. European Review for Medical and Pharmacological Sciences, 11(5), 347-354.

4. Regidor, P.A., Schindler, A.E., Lesoine, B., et al. (2018). Management of women with PCOS using myo-inositol and folic acid. New clinical data and review of the literature. Hormone Molecular Biology and Clinical Investigation, 34(2).

5. Formuso, C., Stracquadanio, M., & Ciotta, L. (2015). Myo-inositol vs. D-chiro inositol in PCOS treatment. Minerva Ginecologica, 67(4), 321-325.

6. Laganà, A.S., Barbaro, L. & Pizzo, A. (2015). Evaluation of ovarian function and metabolic factors in women affected by polycystic ovary syndrome after treatment with D-Chiro-Inositol. Archives Gynecology Obstetrics, 291(5), 1181-1186.

7. Zheng, X., Lin, D., Zhang, Y., et al. (2017). Inositol supplement improves clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET. Medicine (Baltimore), 96(49), e8842.

8. Colazingari, S., Treglia, M., Najjar, R., et al. (2013). The combined therapy myo-inositol plus D-chiro-inositol, rather than D-chiro-inositol, is able to improve IVF outcomes: results from BMC Public Health a randomized controlled trial. Archives Gynecology Obstetrics, 288(6), 1405-1411.

9. Imdad, A., Yakoob, M.Y., & Bhutta, Z.A. (2011). The effect of folic acid, protein energy and multiple micronutrient supplements in pregnancy on stillbirths. BMC Public Health, 11, Suppl 3, S4.

10. Visentin, C.E., Masih, S.P., Plumptre, L., et al. (2016). Low serum vitamin B12 concentrations are prevalent in a cohort of pregnant Canadian women. Journal of Nutrition, 146(5), 1035-1042.