Combined Effect of Myo-Inositol and Folic Acid on Neutrophil to Lymphocyte Ratio and C - Reactive Protein in Patients With Polycystic Ovarian Syndrome

Polycystic Ovary Syndrome (PCOS) is a common endocrine and metabolic disorder affecting women of reproductive age. It is characterised by hyperandrogenism, ovulatory dysfunction, and/or polycystic ovarian morphology, depending on the diagnostic criteria applied. In addition to reproductive and hormonal abnormalities, PCOS is frequently associated with metabolic disturbances, including insulin resistance, obesity, dyslipidaemia, and an increased risk of type 2 diabetes mellitus and cardiovascular disease. Chronic low-grade systemic inflammation has also been increasingly recognised as an important component of PCOS pathophysiology. Women with PCOS may exhibit elevated levels of inflammatory biomarkers, including C-reactive protein (CRP), suggesting the presence of persistent systemic inflammation that may contribute to metabolic and reproductive abnormalities.

The Neutrophil-to-Lymphocyte Ratio (NLR) is a simple, inexpensive, and readily available inflammatory marker derived from the complete blood count. It reflects the relative balance between neutrophil-mediated innate immune responses and lymphocyte-mediated adaptive immune responses and has been investigated as a marker of systemic inflammation in several chronic conditions, including PCOS. Similarly, CRP is an acute-phase protein produced primarily by the liver in response to inflammatory stimuli and is widely used as a biomarker of systemic inflammation. Elevated CRP levels have been reported in women with PCOS and may reflect the inflammatory component of the disorder. Assessment of NLR and CRP may therefore provide useful information regarding changes in systemic inflammatory status following treatment.

Insulin resistance is a common feature of PCOS and may occur regardless of body mass index. It can result in compensatory hyperinsulinaemia, which may stimulate ovarian androgen production and contribute to impaired follicular development, ovulatory dysfunction, and other clinical manifestations of PCOS. The close relationship between insulin resistance, metabolic dysfunction, and inflammation suggests that interventions aimed at improving insulin sensitivity may also influence inflammatory pathways. Metformin is an established insulin-sensitising medication used in the management of selected women with PCOS. It primarily acts by reducing hepatic glucose production and improving insulin sensitivity. Although Metformin may improve metabolic parameters and has been associated with reductions in some inflammatory markers, gastrointestinal adverse effects such as nausea, diarrhoea, abdominal discomfort, and bloating may occur and can affect treatment adherence in some patients.

Myo-Inositol is a naturally occurring compound that participates in intracellular insulin-signalling pathways and has gained attention as a potential therapeutic option for women with PCOS. Through its role in insulin signalling, Myo-Inositol may improve insulin sensitivity and contribute to improvements in ovarian function, hormonal balance, and metabolic parameters. Previous studies have reported potential benefits of Myo-Inositol supplementation in relation to insulin levels, androgen concentrations, menstrual regularity, and ovulatory function in women with PCOS. In addition to these metabolic and reproductive effects, Myo-Inositol may have potential anti-inflammatory properties; however, evidence regarding its effects on systemic inflammatory markers remains limited and requires further investigation.

Folic Acid is an essential water-soluble B vitamin that plays an important role in DNA synthesis, cell division, and one-carbon metabolism. It is routinely recommended for women of reproductive age and is particularly important for women who may become pregnant. Folic Acid supplementation has also been investigated in relation to homocysteine metabolism, oxidative stress, and inflammatory processes. The combination of Myo-Inositol and Folic Acid is commonly used in the management of PCOS because of their potentially complementary effects on metabolic and reproductive health. However, the specific effect of this combination on systemic inflammatory markers such as NLR and CRP has not been adequately established.