Effectiveness of myoinositol versus metformin as adjuvant treatment on infertile PCOS women undergoing ovulation induction cycles prospective cohort study

Background In anovulatory infertility Polycystic ovary syndrome (PCOS) plays a leading role, characterized by endocrine and metabolic disturbances. While metformin is usually used to decrease insulin resistance and restore ovulation, myoinositol has emerged as a promising alternative with fewer side effects. This study aimed to evaluate and compare the effectiveness of metformin and myoinositol as adjuvant treatments in infertile women with PCOS in ovulation induction cycles. Patient and methods This prospective cohort study included 192 women diagnosed with PCOS-related infertility, divided into two groups (n = 96 each) receiving either metformin or myoinositol for 3 months prior to ovulation induction. Clinical, biochemical, and hormonal parameters were recorded at baseline and post-treatment. Ovulation and conception rates were assessed across three induction cycles. Results Both groups showed significant improvements in cycle regularity, hormonal profiles (LH, testosterone, SHBG, and insulin sensitivity (fasting insulin, HOMA-IR). Metformin was associated with a greater reduction in BMI (p < 0.001), cycle length (p < 0.001), fasting insulin level and HOMA-IR index (p < 0.001), as well as higher ovulation rates in the second (44.1% vs. 28.7%, p = 0.029) and third cycles (64.1% vs. 47.6%, p = 0.035). Myoinositol demonstrated a more favorable impact on HDL and LDL cholesterol levels. Conception rates were comparable between groups across all cycles (p > 0.05). Conclusion Both metformin and myoinositol effectively improved reproductive and metabolic parameters in PCOS women through ovulation induction cycles. Metformin showed superior efficacy in enhancing ovulation and insulin resistance, whereas myoinositol may offer benefits in lipid metabolism and is better tolerated. Personalized treatment decisions should consider metabolic profiles, patient preferences, and treatment tolerance.