Metformin, myo-inositol and D-chiro-inositol use and ART outcomes in women with PCOS: current results and future perspectives

Polycystic ovary syndrome (PCOS) remains the most common endocrine disorder in women worldwide. PCOS affects 5-18% of women, and is a reproductive, metabolic, and psychological condition. Oligomenorrhea, obesity, infertility, hyperandrogenemia and insulin resistance (IR) constitute the common features of PCOS. IR has a critical role in the pathogenesis of PCOS. Metabolic abnormalities in PCOS patients are manifested by IR, dysregulation of glucose metabolism, lipid metabolism disorders. The primary defect in IR in PCOS is the postreceptor defect. The association between hyperinsulinemia, hyperandrogenism, and ovulatory dysfunction in PCOS formed a basis for treatment with insulin-sensitizing agents such as inositol derivatives and metformin. Reducing IR in these patients has a positive effect on both metabolic and reproductive outcomes. Current data support the notion that inositol isoforms myo-inositol (MYO), D-chiro inositol (DCI) and metformin may be effective in the treatment of patients with PCOS. In combination with MYO and DCI, it has metabolic and hormonal effects similar to those of merformin in PCOS. In terms of in vitro fertilization/İntractoplasmic sperm injenction (IVF/ICSI) IVF results, both MYO and MYO plus DCI use have positive effects on ovarian response. However, the effects on clinical pregnancy rate (CPR) and live birth rates (LBR) appear to be limited. As a supplement, preventive strategies and IVF results of these treatments are presented and discussed in detail. The controversial aspect of the issue begins at this point and future perspective approaches are presented along with current results. In this review, metabolic, hormonal and reproductive results are collected holistically.