Comment
Author: Admin | 2025-04-28
The work of Wdowiak et al which showed an improvement embryo/blastcocyst formation and PR in patients with PCOS supplemented with 4g of myo-inositol and 400 mcg of folic acid per day compared to PCOS patients only given folic acid [33]. It is key to note that approximately 38% of patients may be resistant to myo-inositol, but studies in which alpha-lactalbulmin was supplemented noted reduction in this resistance. However, these studies were not randomized trials and did not involve patients undergoing IVF thus severely limiting general applicability [34,35,36]. Overall myo-inositol especially when combined with folic acid and melatonin may be a promising adjuvant for any patient with PCOS planning IVF.2. Insulin sensitizersInsulin resistance has previously been shown to have a negative correlation with ovarian sensitivity [37]. Metformin has been the most commonly-studied insulin sensitizer in PCOS patients. Tang randomized patients to 850mg of Metformin versus placebo from the day of ovarian suppression to the day of retrieval and noted a greater clinical pregnancy rate after 12 weeks and a lower rate of OHSS in the Metformin group [38]. A more recent small RCT with 102 overweight and obese PCOS patients randomized to 1000mg of Metformin at time of ovarian stimulation versus placebo showed lower oocyte yield, but similar LBR in the Metformin group [39]. In contrast, Jacob et al in their RCT noted lower clinical PR per cycle started and lower LBR, but a lower risk of OHSS [40]. Tso et al later completed a systematic review and meta-analysis in women on the effect of Metformin before or during IVF/ICSI cycles and found no difference LBRs, but OHSS risk overall was observed to be lower [41]. Other insulin-sensitizing agents have also been studied. In a small RCT, Salamun et al found that Liraglutide, a GLP-1 receptor agonist, in combination with Metformin led to higher cumulative PR over 12 months in women with PCOS undergoing IVF. It is anticipated that GLP-1 receptor agonists may be more commonly utilized in the future as increased clinical experience accumulates and both short and long-term neonatal and infant studies are published. Of note, both the Metformin only group and the Metformin and Liraglutide group experienced a similar weight loss of an of average 7-7.5kg [42].Insulin sensitizers remain an attractive adjuvant in treating PCOS patients planning IVF. While OHSS risk may be mitigated and some limited weight loss may be achieved, it is unclear if these agents could improve oocyte yield and resultant PR and LBR.3. Vitamin DLower than normal Vitamin D levels have been linked to abnormal metabolic outcomes in PCOS patients [43, 44]. Numerous groups have assessed the effect of Vitamin D on outcomes in such women undergoing IVF. Abadia et al performed a cross-sectional study looking at Vitamin D levels in women undergoing ART and noted a positive correlation between vitamin D levels and oocyte fertilization rates. However, no correlation was noted with pregnancy outcomes [45]. This reinforced a prior Iranian study looking at follicular and serum levels of vitamin D. Unfortunately, both the
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