Overcoming inositol resistance

Inositols are chemically identified as hexahydroxycyclohexanes and include a family of nine stereoisomers; among them, myo-inositol (MI) and d-chiro-inositol (DCI) are most widely distributed. Some studies demonstrate defects in tissue availability or altered metabolism of inositol phosphoglycans (IPGs) in PCOS patients, which are likely involved in the insulin resistance and metabolic abnormalities in these women. Recently, several studies have proved their effectiveness in the treatment of metabolic and reproductive abnormalities in patients with PCOS, identifying them as useful and safe strategy to improve PCOS symptoms, trigger spontaneous ovulation, or induce ovulation. Despite the widely established beneficial effects of inositols on metabolic, hormonal, and reproductive PCOS clinical pictures, some women do not respond to inositol treatment, and they are classified as inositol-resistant patients. In MI-resistant patients, who failed to ovulate on monotherapy, a few different agents could be added to improve ovulation and pregnancy rate, particularly α-lactalbumin, clomiphene, and rFSH.