What is the recommended dose of myo-inositol (Inositol) for a woman of reproductive age undergoing egg retrieval as part of In Vitro Fertilization (IVF) treatment?

Recommended Dose of Myo-Inositol for Egg Retrieval in IVF

The recommended dose of myo-inositol for women undergoing egg retrieval as part of IVF treatment is 4000 mg per day (2000 mg twice daily) combined with 400 μg folic acid (200 μg twice daily), started at least 2-3 months before the IVF cycle begins.

Dosing Protocol

• Standard dosing: 2000 mg myo-inositol + 200 μg folic acid taken twice daily (total daily dose: 4000 mg myo-inositol + 400 μg folic acid) 1, 2, 3
• Duration of pretreatment: Begin supplementation 2-3 months (8-12 weeks) before starting the IVF stimulation protocol 1, 3, 4
• Continue throughout: Maintain supplementation through the ovarian stimulation phase until oocyte retrieval 1, 4

Evidence Supporting This Dose

The 4000 mg daily dose has been extensively studied and demonstrates superior outcomes compared to placebo or folic acid alone:

• Improved oocyte quality: Women taking 4000 mg myo-inositol daily showed significantly better oocyte maturity, with more metaphase II oocytes retrieved and fewer immature oocytes compared to placebo 1, 3
• Better fertilization rates: The myo-inositol group achieved 136 fertilized oocytes out of 233 collected (58.4%) versus 128 out of 300 (42.7%) in the placebo group 1
• Enhanced embryo quality: More grade I quality embryos were obtained in the myo-inositol group compared to placebo 1, 3, 5
• Reduced FSH requirements: Women on myo-inositol required fewer total FSH units for stimulation (1850 units mean) and shorter stimulation duration (9.7 days versus 11.2 days in placebo) 1

Clinical Benefits Beyond Oocyte Quality

• Pregnancy rates: In observational studies of 3602 women with PCOS-related infertility, 70% restored ovulation and 15.1% achieved pregnancy with this dosing regimen 1, 2
• Hormonal improvements: After 12 weeks of treatment, testosterone levels decreased from 96.6 ng/mL to 43.3 ng/mL and progesterone increased from 2.1 ng/mL to 12.3 ng/mL 1, 2
• Reduced OHSS risk: The smaller number of retrieved oocytes in myo-inositol-treated patients (while maintaining better quality) may reduce the risk of ovarian hyperstimulation syndrome 1

Combination Therapy Considerations

• Myo-inositol plus D-chiro-inositol: A physiological ratio combination (1.1 g myo-inositol plus 27.6 mg D-chiro-inositol) has shown benefits, but D-chiro-inositol alone (500 mg) does not improve outcomes 5
• The standard 4000 mg myo-inositol + 400 μg folic acid remains the most widely studied and recommended regimen 1, 2, 3

Comparison to Metformin

• Myo-inositol 4000 mg daily demonstrates comparable or superior efficacy to metformin 1700 mg daily for PCOS patients undergoing IVF 4
• Clinical pregnancy rates were significantly higher with myo-inositol (36.0%) versus metformin (18.0%), and cumulative pregnancy rates including frozen embryo transfer were 43.2% versus 22.7% 4
• Myo-inositol showed better improvements in fasting insulin, HOMA-IR, serum AMH, and SHBG compared to metformin 4

Safety Profile

• No moderate to severe side effects were observed at the 4000 mg daily dose across multiple studies 1, 2
• The treatment is well-tolerated with minimal adverse effects reported 1, 2, 3

Important Caveats

• This dosing is particularly well-studied in women with PCOS undergoing IVF, though benefits may extend to other populations 1, 2, 3, 4
• The 2-3 month pretreatment period is critical for achieving optimal oocyte quality improvements—starting supplementation only at the beginning of stimulation is insufficient 1, 3
• While myo-inositol improves oocyte quality and embryo development, it does not guarantee pregnancy success, as multiple factors influence IVF outcomes 1, 4