Effectiveness of inositol, metformin and their combination in women with PCOS undergoing assisted reproduction: systematic review and meta-analysis

Abstract

Objective

Our study aims to compare the effect of metformin, inositol and their combinations on the efficiency in improving outcomes of assisted reproductive technologies in women with PCOS.

Data sources

PubMed, The Cochrane Library, ClinicalTrials.gov, Embase, MEDLINE. The search was performed on studies published before November 14, 2021, to identify articles evaluating the effectiveness of treatment metformin and inositol on ART outcomes.

Study selection

The systematic review was conducted according to the PRISMA 2020 checklist and registered in the PROSPERO 2021 CRD42021287887. Randomized controlled trials (RCTs) in English that compared metformin or inositol or metformin + inositol treatment with placebo or no treatment in women with PCOS undergoing assisted reproduction were included. In addition, RCTs with comparison combination and single metformin or inositol treatment were also included.

Data extraction and synthesis

35 RCTs were included for qualitative analysis reporting on 4668 participants. In group of Metformin treatment were included 1891 patients, in Myo-inositol group − 281, in inositol + metformin group were included 110 participants and in control group (placebo or absence of treatment) − 1865 women with PCOS. 5 meta-analyses were performed. CPR in comparison of metformin and placebo in 1312 patients were higher in metformin group (RR = 1.30, 95% CI: 1.12 to 1.50, p = 0.0004). OHSS was less in metformin (RR = 0.34, 95% CI: 0.17 to 0.69, p = 0.003). However, LBR were not statistically significant (RR = 1.12, 95% CI: 0.93 to 1.36, p = 0.24). In comparison of inositol and no treatment there was also no difference in CPR (RR = 1.37, 95% CI: 0.79 to 2.38, p = 0.26). As for metformin and inositol meta-analysis in 220 patients with PCOS, CPR were higher in inositol group (RR = 1.52, 95% CI: 1.05 to 2.18, p = 0.03). Combination treatment included only two RCTs and was illegible for meta-analysis.

Conclusion

To our knowledge, it is the first meta-analysis that estimates inositol treatment compared to metformin. Based on our systematic review and meta-analysis, metformin seems to be a good option for improving ART outcomes in women with PCOS. However, it is not clear whether inositol usage is adequate. Nevertheless, we need more clinical trials of good quality to answer all questions thoroughly.

摘要

目的

本研究旨在比较二甲双胍、肌醇及其联合在改善多囊卵巢综合征患者辅助生殖技术（ART）结局方面的效果。

数据来源

PubMed、Cochrane图书馆、ClinicalTrials.gov、EMBASE、Medline。该搜索是在2021年11月14日之前发表的研究基础上进行的, 以确定评估二甲双胍和肌醇治疗对ART结局的效果的文章。

资料选择

按照PRISMA 2020检查表进行系统评价, 注册号为PROSPERO 2021 CRD42021287887。在接受辅助生殖的多囊卵巢综合征患者中, 纳入了随机对照试验（RCTs）, 这些试验将二甲双胍或肌醇或二甲双胍+肌醇治疗与安慰剂或不治疗进行比较。此外, 还包括联合治疗和单独应用二甲双胍或肌醇治疗的RCTs。

数据提炼与综合

纳入35篇RCTs, 对4668名受试者进行定性分析报告。二甲双胍治疗组1891例, 肌醇组−281例, 肌醇+二甲双酚组110例, 对照组（安慰剂或未用药）1865例。共进行了5项Meta分析。包含1312例患者, 二甲双胍组的临床妊娠率（CPR）显著高于安慰剂组（RR=1.30, 95%CI：1.12∼1.5, P=0.0004）。二甲双胍组OHSS较少（RR=0.34, 95%CI：0.17∼0.69, P=0.003）。而活产率（LBR）无显著差异（RR=1.12, 95%CI：0.93∼1.36, P=0.24）。肌醇治疗与未治疗组比较, CPR无显著差异（RR=1.37, 95%CI：0.79∼2.38, P=0.26）。对220例PCOS患者进行二甲双胍和肌醇的Meta分析, 肌醇组CPR显著高于二甲双胍组（RR=1.52, 95%CI：1.05∼2.18, P=0.03）。联合治疗只包括两项RCTs, 无法做Meta分析。

结论

据我们所知, 这是第一个将肌醇治疗与二甲双胍进行比较的meta分析。根据我们的系统回顾和meta分析, 二甲双胍似乎是改善多囊卵巢综合征患者ART结局的好选择。然而, 目前还不清楚肌醇的应用量是否足够。然而, 我们需要更多高质量的临床试验来彻底回答所有问题。

Keywords:

• metformin
• inositol
• Polycystic Ovary Syndrome
• ovulation induction
• IVF

关键词:

• 二甲双胍
• 肌醇
• 多囊卵巢综合征
• 促排卵
• IVF

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The author(s) reported there is no funding associated with the work featured in this article.