Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
Homerton Fertility Center, Homerton University Hospital, London, UK.
Acta Obstet Gynecol Scand. 2019 Oct;98(10):1235-1244. doi: 10.1111/aogs.13625. Epub 2019 May 20.
High levels of anti-Mullerian hormone and a high antral follicle count in women with polycystic ovary syndrome, reflecting increased ovarian antral follicles, predisposes them to have a high number of retrieved oocytes with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and an increased risk of ovarian hyperstimulation syndrome. Inositols, which act as insulin sensitizers, have the potential to alter folliculogenesis and the functional ovarian reserve, with subsequent benefits to reproductive outcomes following IVF/ICSI treatment. Published literature is, however, unable to provide definitive evidence of its efficacy. The objective of our review was to evaluate the effect of inositols on anti-Mullerian hormone, antral follicle count and reproductive outcomes in women with polycystic ovary syndrome undergoing IVF/ICSI.
We performed a literature search using standard methodology recommended by Cochrane. Randomized controlled trials and non-randomized studies comparing inositols with no treatment, placebo or other treatment were included in the review. Using standard methodology recommended by Cochrane we pooled results using the random effects model; our findings were reported as relative risk or mean differences. PROSPERO registration: CRD42017082275.
We included 18 trials. The primary outcome was a change in anti-Mullerian hormone and antral follicle count before and after treatment, for which data were unsuitable for meta-analysis. A narrative review showed no consistent direction or size of effect. A meta-analysis for the secondary outcomes showed no evidence of a significant difference between inositol and control groups for any outcome: number of oocytes (mean difference -0.39, 95% confidence interval [CI] -1.11 to 0.33), number of metaphase II oocytes (mean difference 0.29, 95% CI -0.83 to 1.40), number of top grade embryos (risk ratio [RR] 1.02, 95% CI 0.93-1.12), clinical pregnancy rate (RR 1.16, 95% CI 0.87-1.53), and risk of ovarian hyperstimulation syndrome (RR 0.73, 95% CI 0.39-1.37). The quality of evidence was assessed as very low.
There is insufficient evidence for an effect of inositols on ovarian reserve markers and to support their use as pretreatment before IVF/ICSI in women with polycystic ovary syndrome.
患有多囊卵巢综合征的女性体内抗苗勒管激素水平较高，且窦卵泡计数较高，这反映了卵巢窦卵泡数量增加，这使她们在体外受精（IVF）/胞浆内单精子注射（ICSI）中获得了大量可回收卵子，并增加了卵巢过度刺激综合征的风险。肌醇作为胰岛素增敏剂，具有改变卵泡发生和功能性卵巢储备的潜力，随后对 IVF/ICSI 治疗后的生殖结局带来益处。然而，已发表的文献无法提供其确切疗效的明确证据。本综述的目的是评估肌醇对多囊卵巢综合征女性 IVF/ICSI 前抗苗勒管激素、窦卵泡计数和生殖结局的影响。
我们使用 Cochrane 推荐的标准方法进行了文献检索。纳入了比较肌醇与无治疗、安慰剂或其他治疗的随机对照试验和非随机研究。我们使用 Cochrane 推荐的标准方法，使用随机效应模型对结果进行了汇总；我们的发现以相对风险或平均差异报告。PROSPERO 注册号：CRD42017082275。
我们纳入了 18 项试验。主要结局是治疗前后抗苗勒管激素和窦卵泡计数的变化，对于这些数据，我们无法进行荟萃分析。叙述性综述显示，没有一致的方向或大小的影响。对于次要结局的荟萃分析表明，在任何结局方面，肌醇组与对照组之间均无显著差异：卵母细胞数量（平均差异-0.39，95%置信区间[CI] -1.11 至 0.33）、中期 II 级卵母细胞数量（平均差异 0.29，95% CI -0.83 至 1.40）、优质胚胎数量（风险比[RR] 1.02，95% CI 0.93-1.12）、临床妊娠率（RR 1.16，95% CI 0.87-1.53）和卵巢过度刺激综合征的风险（RR 0.73，95% CI 0.39-1.37）。证据质量被评估为极低。
没有足够的证据表明肌醇对卵巢储备标志物有影响，不能支持在多囊卵巢综合征女性进行 IVF/ICSI 前将其作为预处理使用。
