Pre-treatment effect of myo-inositol and l-5, methyltetrahydrofolate in ovulation induction oocyte quality and pregnancy outcome in clomiphene resistance polycystic ovarian disease

Background: This study was designed to assess the treatment effect of myo-inositol and l-5, methyltetrahydrofolate in oocyte quality, pregnancy outcome in clomiphene citrate resistance PCOS cases.Methods: Authors conducted prospective open label, randomized, parallel group study in SIMS Hapur, U.P. Eligible patients full filling inclusion criteria were randomized into two groups having 25 patients in each group using myo-inositol 580mg and l-5, methyltetrahydrofolate 800mcg in treatment group and tab folic acid 400mcg in placebo group for 12 weeks. The follow-up visits are on weeks 4, 8 and 12.Results: 12 weeks later, 21 patients in treatment group restored one spontaneous menstrual cycle and 19 patients maintained the normal ovulatory activity in follow up cycle. Ovulation induction done in 18 patients with clomiphene citrate at the dose of 50mg during treatment out of which 10 conceive, as compared with only 9 women out of the 25 women (36 percent) in the placebo group ovulate (P>0.001) out of which 4 conceived. There was significant decrease in Sr. testosterone, DHEA and AMH level and estradiol level, while statically significant increase in Sr. SHBG and FSH level seen in treatment group(p<0.001).Conclusions: In the study, more number of studied patients get back to normal menstrual cyclicity, insulin-lowering activity and its intracellular role in oocyte maturation. Significant Dec seen in serum estradiol level at the day of HCG administration.