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Written by Wellness Club on November 24, 2012 – 12:06 pm -

Myo-inositol in the Treatment of PCOS and Non-PCOS Infertility

 

By Dr. Dana Myatt

 

Inositol is part of the vitamin B complex. It occurs as 9 different isomers, but only two of these are of interest in fertility: myo-inositol (MYO) and d-chiro-inositol (DCI)

Both MYO and DCI have been studied and found useful in the treatment of PCOS (PolyCystic Ovary Syndrome). (1-14)

However, only MI has been show to be present in follicular fluid and only MI was able to improve oocyte and embryo quality(1,2,9,12,15), ovulation induction (6-8,10-11) and hormone balance. (3-5,13)

DCI does not have even remotely as much research behind it as MYO. (16)

Therefor, for fertility issues with or without PCOS, I recommend the myo-inositol form.

Please note that some of these studies used melatonin in combination with myo-inositol (2,11-12). Melatonin alone has also been studied and found useful for improving egg quality. (17-18)

Myo-inositol may also improve other associated risks of PCOS (such as high triglycerides and blood sugars) with or without an effect on egg quality. (3,5,7)

Most forms of inositol available in health food stores are probably the myo-inositol form. However, many products do not specify this on the label. I would always want to verify the actual form with the manufacturer before using.

A product called “Pregnitude” is available, containing myo-inositol plus folic acid. Several studies used myo-inositol with folic acid and found improved egg quality in PCOS. (9,11)  All pre-pregnant women should already be getting folic acid from their multiple because of it’s importance in preventing spina bifida. This makes the “magic” in Pregnitude the myo-inositol. Pregnitude is individually packaged by 2 gram serving, which is convenient, but the price is double what what most myo-inositol powders are.

Daily dose of myo-inositol for improving egg quality is 2-4 grams per day. This can be taken as 2 grams, once or twice daily.

Myo-inositol product has a mild sweet taste and can be taken in water, smoothie, Super Shake — whatever makes it easiest.

Egg Quality Protocol, Especially for PCOS Patients (Dr. Myatt’s recommendation based on the studies)

1. myo-inositol: 2-4 grams per day
2. melatonin: 3mg per day (take this at bedtime)
3. folic acid: 400mcg (this amount or more should already be in a good multi-vitamin)

 

[Nurse Mark comment: Any woman seeking to improve or enhance fertility should be using a good quality Optimal Dose multivitamin – we recommend Maxi Multi of course – but for those who want to shop around for something else, please use the ingredient list on the Maxi Multi page as a reference for what an Optimal Dose multivitamin should contain.]

 

References
1.) Ciotta L, Stracquadanio M, Pagano I, Carbonaro A, Palumbo M, Gulino F. Effects of myo-inositol supplementation on oocyte’s quality in PCOS patients: a double blind trial. Eur Rev Med Pharmacol Sci. 2011 May;15(5):509-14. [##myo for PCOS##]
2.) Carlomagno G, Nordio M, Chiu TT, Unfer V. Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):267-72. Epub 2011 Aug 10.
Contribution of myo-inositol and melatonin to human reproduction. http://www.ncbi.nlm.nih.gov/pubmed/21835536 [###myo and melatonin; egg quality##]
3.) Costantino D, Minozzi G, Minozzi E, Guaraldi C. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):105-10.  {## myo for PCOS; hormones and metabolic factors##]
4.) Donà G, Sabbadin C, Fiore C, Bragadin M, Giorgino FL, Ragazzi E, Clari G, Bordin L, Armanini D. Inositol administration reduces oxidative stress in erythrocytes of patients with polycystic ovary syndrome.Eur J Endocrinol. 2012 Apr;166(4):703-10. Epub 2012 Jan 5. [##MYO improves oxidative stress (decreases oxidative species), improves hormones in PCOS##]
5.) Genazzani AD, Lanzoni C, Ricchieri F, Jasonni VM. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome.Gynecol Endocrinol. 2008 Mar;24(3):139-44.[##MYO; menstrual cycle improvements; better non-fertility numbers; 2 grams per day##]
6.) Gerli S, Mignosa M, Di Renzo GC. Effects of inositol on ovarian function and metabolic factors in women with PCOS: a randomized double blind placebo-controlled trial. Eur Rev Med Pharmacol Sci. 2003 Nov-Dec;7(6):151-9. [##myo, PCOS, ovulation induction##]
7.) Gerli S, Papaleo E, Ferrari A, Di Renzo GC. Randomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOS. Eur Rev Med Pharmacol Sci. 2007 Sep-Oct;11(5):347-54. [## MYO, PCOS, improved ovulation, improved non-fertility peramiters (including weight loss)}
8.) Morgante G, Orvieto R, Di Sabatino A, Musacchio MC, De Leo V. The role of inositol supplementation in patients with polycystic ovary syndrome, with insulin resistance, undergoing the low-dose gonadotropin ovulation induction regimen.Fertil Steril. 2011 Jun 30;95(8):2642-4. Epub 2011 Feb 5. [myo, PCOS, ovulation induction##]
9.) Papaleo E, Unfer V, Baillargeon JP, Fusi F, Occhi F, De Santis L. Fertil Steril. 2009 May;91(5):1750-4. Epub 2008 May 7. Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. [##myo+ folic acid for egg quality in PCOS##]
10.) Papaleo E, Unfer V, Baillargeon JP, De Santis L, Fusi F, Brigante C, Marelli G, Cino I, Redaelli A, Ferrari A. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction.Gynecol Endocrinol. 2007 Dec;23(12):700-3. Epub 2007 Oct 10. [##myo for ovulation in PCOS##]
11.) Rizzo P, Raffone E, Benedetto V. Effect of the treatment with myo-inositol plus folic acid plus melatonin in comparison with a treatment with myo-inositol plus folic acid on oocyte quality and pregnancy outcome in IVF cycles. A prospective, clinical trial. Eur Rev Med Pharmacol Sci. 2010 Jun;14(6):555-61. [##myo+folic acid+melatonin##]
12.) Unfer V, Raffone E, Rizzo P, Buffo S. Gynecol Endocrinol. 2011 Nov;27(11):857-61. Epub 2011 Apr 5. Effect of a supplementation with myo-inositol plus melatonin on oocyte quality in women who failed to conceive in previous in vitro fertilization cycles for poor oocyte quality: a prospective, longitudinal, cohort study. http://www.ncbi.nlm.nih.gov/pubmed/21463230  [##myo and melatonin##]
13.) Unfer V, Carlomagno G, Dante G, Facchinetti F. Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecol Endocrinol. 2012 Jul;28(7):509-15. doi: 10.3109/09513590.2011.650660. Epub 2012 Feb 1. {##myo and improved ovarian function##]
14.) Nestler JE, Jakubowicz DJ, Reamer P, Gunn RD, Allan G. Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome. N Engl J Med. 1999 Apr 29;340(17):1314-20.[##DCI for PCO##]
15.) Galletta M, Grasso S, Vaiarelli A, Roseff SJ. Bye-bye chiro-inositol – myo-inositol: true progress in the treatment of polycystic ovary syndrome and ovulation induction. Eur Rev Med Pharmacol Sci. 2011 Oct;15(10):1212-4. {####myo for egg quality, not dci)
16.) Galazis N, Galazi M, Atiomo W. D-Chiro-inositol and its significance in polycystic ovary syndrome: a systematic review.Gynecol Endocrinol. 2011 Apr;27(4):256-62. Epub 2010 Dec 10.[##DCI not much research##]
17.) Batioglu AS, Sahin U, Gürlek B, Oztürk N, Unsal E. The efficacy of melatonin administration on oocyte quality. Gynecol Endocrinol. 2012 Feb;28(2):91-3. Epub 2011 Jul 20. [##melatonin##]
18.) Tamura H, Takasaki A, Miwa I, Taniguchi K, Maekawa R, Asada H, Taketani T, Matsuoka A, Yamagata Y, Shimamura K, Morioka H, Ishikawa H, Reiter RJ, Sugino N. Oxidative stress impairs oocyte quality and melatonin protects oocytes from free radical damage and improves fertilization rate. J Pineal Res. 2008 Apr;44(3):280-7.
[##melatonin##]

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