Myoinositol vs. Metformin: A Meta-Analytic Approach to Addressing PCOS-Induced Infertility

Abstract

BACKGROUND: The condition of PCOS exists in more than 10% of women globally within their reproductive years and causes hormonal imbalance and insulin resistance together with infertility issues. The medications MET (metformin) and MI (Myoinositol) were found to relieve the symptoms of PCOS and associated challenges of insulin resistance, testosterone levels, and follicle-stimulating hormone (FSH).

OBJECTIVE: The main goal of this study is to conduct a meta-analysis that evaluates the effects of Metformin and Myoinositol on HOMA-IR, testosterone and FSH markers in PCOS patients.

METHODS: A meta-analysis was conducted in this study to evaluate MET Vs. MI effectiveness on PCOS. The literature search based on PRISMA guidelines was conducted on six electronic databases (MEDLINE, EMBASE, PubMed, Scopus, Google Scholar, and ResearchGate) from 2010 to 2024. A total of thirty randomized clinical comparative studies with a comparison of Metformin and Myoinositol were selected based on exclusion and inclusion criteria. Statistical analysis through standardized mean differences (SMD) under a random-effects model to account for heterogeneity was conducted.

RESULTS: The meta-analysis, including thirty randomized clinical comparative studies, showed that FSH levels between MET and MI were similar because the difference was statistically insignificant (SMD= -0.11, 95% CI: -0.44 to 0.22, I²= 86%). Testosterone levels also showed no major differences among research studies, resulting in a nonsignificant outcome for MET (SMD= 0.61, 95% CI: -0.98 to 2.21, I²= 98%). The medium but insignificant effect in HOMA-IR reduction was found when patients received MET (SMD= -0.24, 95% CI: -0.69 to 0.22, I²= 92%). The wide range of patient characteristics during different treatment periods appeared to cause high heterogeneity across analyzed studies.

CONCLUSION: Both Metformin and Myoinositol show similar effects on FSH, testosterone, and insulin resistance in PCOS patients. The analysis results demonstrated that MET enhanced insulin sensitivity, although it failed to produce statistically significant data for PCOS patients. Future research needs to investigate the long-term outcomes together with developing personalized therapeutic methods.