Efficacy of pretreatment D-chiro-inositol and cyproterone acetate-ethinyl estradiol combination therapy compared to cyproterone acetate-ethinyl estradiol alone for ovarian response in polycystic ovary syndrome with high AMH

Background: Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility, often associated with elevated AMH levels. This study evaluates whether adding D-chiro-inositol to cyproterone acetate–ethinyl estradiol improves ovarian response in PCOS women with high AMH. To assess the effects of pre-treatment with D-chiro-inositol and Cyproterone acetate-ethinyl estradiol compared to Cyproterone acetate-ethinyl estradiol alone for ovarian response in high AMH patient of PCOS. Methods: This open-label randomized controlled trial was conducted at the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka, from July 2023 to June 2024. Sixty sub-fertile women with PCOS were randomized into two groups (n=30). Data were analyzed using SPSS version 25.0 and comparisons between groups were made using the Chi-square test, t-test or Mann-Whitney U test as appropriate. A p-value of <0.05 was considered statistically significant. Results: Serum AMH and LH levels significantly decreased in both groups, with no significant difference between them. Although the experimental group showed a slightly higher ovarian response (74.07% compared to 69.23% in cycle 1; 76.92% compared to 72.73% in cycle 2), this was not statistically significant. Similarly, cumulative ovulation and pregnancy rates did not differ significantly between groups. Conclusions: Pre-treatment with D-chiro-Inositol and cyproterone acetate–ethinyl estradiol combination therapy compared to cyproterone acetate–ethinyl estradiol alone, provides similar efficacy in terms of hormonal profile changes, ovarian response, cumulative ovulation rate and cumulative pregnancy rate in PCOS with high AMH.