Myo-Inositol For Fertility & Effects In Women With PCOS
Most non-prescription supplements today claim to have some magical effects on reproductive health and fertility, in part since the claims the supplement manufacturers make don’t get vetted by FDA. But, there is one supplement that has managed to stand out as an auspicious exception, and a growing body of studies suggests its impact: a number of insulin-sensitizing compounds known as inositols such as Myo-inositol.
There is a decent track record for regulating ovulation and changing reproductive hormone levels. Studies on inositols that have been done to date relate to insulin resistance and PCOS (polycystic ovary syndrome). Unlike how these supplements get marketed, there is no evidence that they are suitable for everyone. We know so far that inositols can help regulate ovulation and hormone levels in women with insulin sensitivity and PCOS; however, even in these conditions, there are effective prescription medications doctors use as the first-line treatments.
So, suppose you are someone without insulin resistance or PCOS. In that case, there’s no evidence at the moment that inositols can boost fertility in relation to unassisted reproduction – and any proof that they can affect assisted reproduction outcomes positively needs to be considered preliminarily.
Most reproductive endocrinologists also agree that the data to support the clear Myo-inositol benefits for women with polycystic ovary syndrome isn’t quite available now. But there is a growing body of research, and the chances are that we will find the benefits soon enough. Better and large studies are still needed, and researchers need to exercise caution to avoid generalizing the benefits the PCOS patients to other groups where the benefits haven’t been proven.
In this post, we will discuss how Myo-inositol can assist your fertility and boost your reproductive health.
Inositols, insulin and fertility
Insulin, a hormone made in the pancreas, gets released into the bloodstream to help turn sugars into energy that may be used immediately or stored for use when the need arises. If someone is insulin-resistant, then it means that their body cells are not responding similarly to the insulin in the bloodstream. This will cause the pancreas to produce more insulin, trying to compensate and regulate glucose levels.
Think of insulin- resistance as an accelerator pedal. When you push the pedal down and the vehicle doesn’t start to move, you will probably try to push the pedal harder, trying to compensate. The body producing more of the hormone insulin is the equivalent of pressing the accelerator pedal harder.
So, how does this affect fertility and reproductive health? The hormone insulin usually has an interconnected relationship with essential reproductive hormones and proteins:
- The insulin receptors can be found on ovary cells, which can alter the processes related to fertility and reproductive health. Particularly, insulin can cause the ovaries to produce higher levels of androgen (male sex hormone) testosterone, a hallmark feature of PCOS.
- Insulin will also play a vital role in producing the sex hormone-binding globulin (SHBG) – When the insulin levels go up, the SHBG levels will go down. Sex hormone-binding globulin binds to the hormones in the bloodstream, making it difficult for them to cause physiological changes effectively. If the SHBG levels are low, which usually occurs when the insulin levels are high, the unbound androgens will be higher, meaning there are more free hormones to float and act on various parts of the body. When the androgens activity increase, they can aggravate the symptoms of androgen-related PCOS.
Several prescription medications can be taken to minimize the insulin resistance levels:
- Insulin sensitizers: These are some of the popular and effective medications in the metformin class and are usually prescribed for diabetes and sometimes for polycystic ovary syndrome.
- Inositol-based supplements: Different forms of inositols such as d-chiro- inositol and myo-inositol have been proven to be efficient in the context of PCOS and diabetes, and the physiological symptoms are similar to those of metformin.
Myo-inositol & individuals with PCOS?
Although there isn’t much evidence on the effectiveness of the non-FDA regulated supplements and compounds, Myo-inositol has still managed to stand out. A growing collection of peer-reviewed information (from reviews, individual studies, and meta-analyses) suggests that Myo-inositol can enhance cycle regulation, hormone levels, and ovulation in people with PCOS. They still have insulin resistance and high androgen levels.
Below are some spotlights from the available data:
- A study involving 130 individuals with insulin resistance and PCOS revealed that the people who took myo-inositol were six times likely to have regular menstrual cycles than those who got the placebo. A third group was also treated with the d-chiro-inositol, and no differences were found between the d-chiro-inositol and myo-inositol groups.
- Another study compared the frequency of ovulation in women with PCOS who got treated with a placebo or Myo-inositol. The results found that 70% of the women who got Myo-inositol ovulated, but only 21% of those in the placebo group did. Those in the myo-inositol group also saw a tremendous decrease in testosterone levels. Another older similar study that treated people with d-chiro-inositol also had similar results.
- A study conducted in 2016 placed metformin and Myo-inositol head-to-head. They realized that the effects of the treatment on menstrual cycle regularity were similar for the two treatments.
Simply put, the science behind ovulation, Myo-inositol and people with PCOS & insulin resistance is still promising. Myo-inositol can aid in regulating ovulation and the levels of the reproductive hormones. Although the published studies suggest that Myo-inositol might have outstanding positive effects, the sample sizes here are small – one recent meta-analysis on this subject combined data from less than four hundred people – which means more data is needed before making any conclusions with confidence.
Based on the available publications, do inositols appear to be an ideal option for individuals with insulin resistance and PCOS and would like to regulate their cycles? According to certain doctors, there is no harm in taking it for some months as you keep close track of your cycles.
If you realize that things aren’t changing, you can try something else like combining a hormonal IUD, an implant, and oral contraceptives. There are health risks (such as increased endometrial cancer risks) to experiencing anovulatory cycles and the unopposed estrogen levels that accompany them. Drugs with progestin or those that have an impact on endometrium can be vital in mitigating the risks.
Consulting with your doctor to know more about your symptoms and reproductive goals is essential as it will assist you in picking an ideal treatment plan.
Although signs seem to point to myo-inositol affecting hormones and ovulation in specific groups, there is minimal evidence that this supplementation can influence other areas of fertility. Myo-inositol does not seem to boost clinical pregnancy and live birth rates for individuals with PCOS in relation to unassisted conception or cases where ART (assisted reproductive technology) like in vitro fertilization is used.
That said, the ASRM (American Society of Reproductive Medicine) is still recommending the use of traditional fertility treatments such as Clomid and Letrozole over inositol and metformin as the primary supplements for anovulation in women with PCOS.
Myo-inositol & women who don’t have PCOS?
This is the area where science becomes somewhat sparse. While it is true that some data shows that Myo-inositol can actually help in regulating hormone levels and ovulation for a group of people with PCOS, it is not clear if it can work the same way for people without PCOS. There weren’t any placebo-controlled studies we could get that determine whether Myo-inositol can increase ovulation regularity or change hormone levels in individuals who do not have PCOS. Likewise, there is no research assessing if the pregnancy or conception rates can be influenced by myo-inositol intake among people without PCOS.
Myo-inositol & IVF
A study compared the outcomes of ART in women undergoing ovarian hyperstimulation procedures. One group of participants was given the usual hyperstimulation meds, as well as folic acid and myo-inositol. The pregnancy and implantation rates in both groups were comparable, but in the group which also got inositol, some lower doses of the hyperstimulation medications were required. The same results with minimal hyperstimulation medication may suggest that Myo-inositol positively impacted egg development, but the authors insisted that follow-up studies are required.
A randomized controlled trial that involved 60 individuals who were classified as ‘poor ovarian responders’ revealed that people who got Myo-inositol. As well as other hyperstimulation meds (like medication with hormones that signal the testes or ovaries to release hormones), had a matching number of eggs retrieved, pregnancy rates, and a number of embryos. The only thing that was higher in the myo-inositol group was the fertilization rates. More extensive studies are required to determine if some existing differences were not detected because the number of participants was limited.
Another small study of individuals with infertility noticed some hints that the supplementation of myo-inositol could have anti-inflammatory and antioxidant effects that might boost fertility. While the initial findings are more encouraging and need further study, additional studies with robust techniques and large samples sizes are needed before one can get excited.
There are no convincing statistics that myo-inositol can really boost fertility amongst people with PCOS, but some have tried taking it to enhance insulin sensitivity. A collection of data from 502 pregnant women across four trials found that Myo-inositol supplementation can result in low cases of gestational diabetes. However, aggregated data quality is still low, so more research is needed before weighing in on this subject confidently.
What is known about myo-inositol and people with sperm?
Multiple studies have noted the significant improvements in the sperm quality and quantity metrics after men start taking myo-inositol. But the studies didn’t involve a control group, so it’s still hard to interpret the results. The way Myo-inositol works inside the male body to increase the semen is still unclear and not fully researched, but there are reasons to believe that Myo-inositol can make the cells in testes more sensitive to hormones such as FSH that play an essential role in testicular sperm production.
Why are there multiple varying myo-inositol supplements?
Due to the relatively small number of individuals who can benefit from taking myo-inositol supplementation (based on the information we have), there are many myo-inositol supplements out there that have general fertility claims. Since these are supplements, the companies do not need to give the FDA their data to back up all their claims.
Even when they conduct reference studies, they usually focus on individuals with PCOS. So far, we have seen that this supplement works well for a subgroup of people with PCOS, though it does not mean that it will work well for people with PCOS or those without PCOS.
With saying that, there has not been any scientific research to show that there is the harm in taking myo-inositol to increase your ovualtion and semen quality other than the known side effects such as headaches and fatigue.
This means that if myo-inositol supplementation doesn’t assist everyone, it likely will not hurt them either. However, spending money and time on the myo-inositol supplements can mean less money and time spent on the other science-backed ways to enhance ovulation regularity (the use of Clomid and Letrozole).
Which are the medications the ASRM recommends for people as first-line treatment over the intake of metformin and inositol. This doesn’t mean you cannot take myo-inositol and Letrozole or Clomiphene citrate together.
How can you tell if myo-inositol supplements will work for you?
Depending on what we know about fertility and myo-inositol, there is one group of individuals it may have a significant benefit for: people with insulin resistance, PCOS, and high testosterone levels who are not ovulating regularly. Here are various proactive steps you can take to know if you fall into this category.
- Check the levels of your reproductive hormones. PCOS is usually associated with variations in testosterone, a follicle-stimulation hormone to luteinizing hormone ratio, and anti-Mullerian hormone (AMH). Knowing the actual state of your hormonal baseline is the first step to understanding ovarian function. You can rely on a fertility hormone test for AMH and even measure LH and FSH if you have regular cycles and are not on hormonal birth control.
- Keep track of the luteinizing hormone to understand ovulation better. Luteinizing hormone tests are the easiest at-home ways to determine if you are ovulating regularly. Women with PCOS might see that they are ovulating irregularly or not at all. The ovulation test from Fertility2Family will allow you to track your menstrual cycle and increase your chances of conception.
- Consult with your doctor about your hormone levels, ovulatory and menstrual patterns, and any other vital data points or symptoms related to reproductive health.
Additionally, it’s essential to remember that reproductive endocrinologists might not recommend a kind of inositol as the first-line treatment for women who are hoping to ovulate regularly. While insulin-sensitizing agents might help regulate the ovarian function in specific individuals, when you compare them to medications like Clomid, they are not as effective in enhancing ovulation or pregnancy.
The bottom line: Inositol supplements for women with PCOS
Currently, inositol-based supplements are being marketed as the most reliable way to balance hormones, promote reproductive health and regulate reproductive health. Although these supplements can affect hormone levels and ensure a certain subgroup of people have regular ovulation, they do not always work on everyone. In no subcategory of people are the supplements more effective than the ovulation inductions medications prescribed today.
There is no known harm in taking myo-inositol or any other inositol-based supplements. With that said, if you experience any symptoms that cause you to think myo-inositol is for you, it is advisable to consult with your health care provider first.