Selecting the women for myo inositol

Myoinositol for whom?? Firstly, Hyperinsulinemia with resultant hyperandrogenaemia is a major cause of PCOS. It is believed that persistent ovarian hyperandrogenaemias is the cause of follicular arrest in such women. But anovulation, Obesity, vascular changes and hepatic changes as observed in PCOS women though have a common etiology (insulin Resistance) –but the mechanism of damage of each type of organ is different. Different pathways are involved in causing ill effects on the cells.

Secondly, if we can decrease the intensity of hyperinsulinaemia by some oral agents then hopeful the ovarian milieu will become favourable and will pave the way of proper follicular growth.

Thirdly, not all IR are of same genetic origin. That is why Diabetologist goes on changing oral agents and to my knowledge there are about eight such oral agents used as oral anti diabetic drugs (OAD). Diabetologist, quite often go on changing such oral agents if desired results are not observed with primary drug.

As a corollary, if we presume one particular PCOS woman is having ovarian hyperandrogenaemia induced by  hyperinsulinaemia/ IRà then what is te harm in trying another / alternative agent to reduce ovarian hyperandrogenemia if metformin/ wt reduction, exercise & CC/ Anastrazole do not work. ?  Further, not all insulin sensitizer’s work in all organs of body identically, And Myo-inositol (one type of alcohol) preferentially acts on ovary.

Then question is:-To whom to prescribe MI? Who are the ideal candidates for MI? How do we identify such women? There is some urine test (beg to be excused for poor memory) which can pick up who are probably going to response with M