Myoinositol, Metformin and Sitagliptin as Adjuncts to Clomiphene Citrate for Ovulation Induction in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial.

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder characterized by anovulation and insulin resistance. Its pathogenesis is heavily influenced by insulin resistance, and insulin-sensitizing medications like metformin and myo-inositol are commonly utilized to improve ovulatory responsiveness. Dipeptidyl peptidase-4 (DPP-4) inhibitors, such sitagliptin, have recently come to light as viable treatment choices for PCOS's metabolic and reproductive abnormalities. This study aimed to compare the efficacy of insulin sensitizer myoinositol plus clomiphene citrate versus a combination of metformin plus clomiphene citrate versus sitagliptin in combination with clomiphene citrate for ovulation induction in polycystic ovarian syndrome. Methods: Sixty women with PCOS were randomly assigned to three equal groups. Group A received myo-inositol (1 g twice daily), Group B metformin (500 mg three times daily), and Group C sitagliptin (100 mg once daily), each combined with clomiphene citrate for up to three ovulatory cycles. Ovulation, menstrual regularity, HOMA-IR, and conception rates were assessed. Results: All three regimens improved menstrual regularity, LH/FSH ratio, and insulin sensitivity. Mean HOMA-IR decreased from 3.34±2.20 to 2.50±1.45 in the myo-inositol group, 3.30±1.90 to 3.10±1.95 in the metformin group, and 3.25±2.25 to 2.80±1.30 in the sitagliptin group (p=0.495). Conception occurred in 40%, 30%, and 35% of participants, respectively (p=0.802). Conclusion: All three insulin-sensitizing agents myo-inositol, metformin, and sitagliptin demonstrated comparable reproductive and metabolic outcomes when combined with clomiphene citrate in women with polycystic ovary syndrome (PCOS). [ABSTRACT FROM AUTHOR]