WAYS TO IMPROVE IN VITRO FERTILIZATION OUTCOMES IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME PHENOTYPES A AND D (INO-1)

Objective: To study the effect of the combination of myoinositol (MI) and α-lactalbumin (α-LA) on the quality of oocytes and embryos and to evaluate the effectiveness of in vitro fertilization (IVF) treatment in patients with polycystic ovary syndrome (PCOS) taking into account the presence of insulin resistance and polymorphic variants of the follicle-stimulating hormone (FSH) receptor gene. Materials and methods: An observational comparative single-center INO-1 study enrolled 224 patients with infertility and PCOS (phenotypes A and D) who were screened for insulin resistance and FSH receptor gene polymorphisms (Asn680Ser). The patients were randomly divided into four groups depending on the presence or absence of insulin resistance and polymorphic variants of the FSH receptor gene: group 1 (n=52) had FSH receptor gene polymorphism (+), insulin resistance (-), group 2 (n=55) had FSH receptor gene polymorphism (-), insulin resistance (+), group 3 (n=59) had FSH receptor gene polymorphism (+), insulin resistance (+), group 4 (n=58) had FSH receptor gene polymorphism (-), insulin resistance (-). Depending on the type of therapy, the patients in each group were divided into two subgroups. The patients of the 1st subgroup received a combination of MI 600 mg+a-LA+folic acid 200 mcg (Inofert Forte, ITALFARMACO, Italy) one capsule twice a day, orally, for a course duration of 3 months before starting the IVF program. The patients of the 2nd subgroup received folic acid 400 mcg per day routinely, orally, for a course duration of 3 months before starting the IVF program. The quality of oocytes and embryos and the pregnancy rate per embryo transfer in the IVF programs after preconception supplementation with MI+ α-LA combination were evaluated. Results: The rate of mature oocyte retrieval was significantly higher in patients of subgroup 1 with insulin resistance (groups 2 and 3) who received MI+ α-LA supplementation compared to patients of subgroup 2 who received folic acid supplementation routinely. This rate was 80.8% versus 51.7% (p=0.045) in group 2 and 64.5% versus 35.7% (p=0.027) in group 3. The rate of obtaining good quality embryos was significantly higher in patients of subgroup 1 in groups 2 and 3, namely 65.4 % versus 37.9 % (p=0.042) in group 2 and 54.8 % versus 28.6 % (p=0.041) in group 3. Comparable results were obtained when the pregnancy rate per embryo transfer in IVF programs was assessed in those insulin-resistant patients who were administered the MI+ α-LA combination. The outcome of IVF programs in group 2 was 53.8% versus 27.6% (p=0.047) and the outcome in group 3 was 41.9% versus 17.9% (p=0.045). Conclusion: The administration of the MI+ α-LA combination (Inofert Forte, ITALFARMACO, Italy) to patients diagnosed with PCOS and insulin resistance before the IVF treatment is advisable, as it helps to correct insulin resistance and increase ovarian sensitivity to gonadotropins. This results in obtaining mature oocytes and embryos of good quality and increases the pregnancy rate. © 2025 Elsevier B.V., All rights reserved.