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Evaluating the Therapeutic Potential of Antioxidants in Polyendocrine Metabolic Ovarian Syndrome (PMOS)-Associated
Pramathes Das Mahapatra1, Vidya Vishwanath Bhat2, Noopur Ajaykumar Vyas3
1Gynaecology & Obstetrics, Spectrum Clinic, Kolkata, WB, India.
Introduction:
Polyendocrine Metabolic Ovarian syndrome (PMOS) formerly known as polycystic ovarian syndrome (PCOS) constitutes the most common endocrinopathy in women of reproductive age group. Evidence from numerous studies in PMOS patients suggests that antioxidants can modulate the ovarian microenvironment, promote folliculogenesis, and increase oocyte competence and yield. This review aims to summarize the existing clinical evidence regarding the application of antioxidants as adjunctive treatment options in the management of PMOS-related infertility.
Materials And Methods:
This is a structured narrative review. A literature search (1990-2024) was conducted through PubMed, Google Scholar, and Cochrane Library to identify clinical trials evaluating the role of antioxidants specifically Coenzyme Q10 (CoQ10), N-acetylcysteine (NAC), melatonin, and astaxanthin (AST) in PMOS. Studies were identified and screened based on the predefined eligibility criteria. Inclusion criteria were full-text, English-language studies assessing antioxidant interventions in PMOS or related mechanisms; exclusions were reviews, meta-analyses, animal studies, duplicates, and non-English articles. Of 198 records screened, 28 studies met eligibility criteria and were included in this review.
Results:
Based on the data included in our review, the available evidence suggests that CoQ10 enhances mitochondrial function and reduces oxidative stress (OS). It has been reported to increase clinical pregnancy rates, improve insulin sensitivity, sex hormone levels, and blood lipids. N-acetylcysteine scavenges free radicals, provides cysteine for glutathione synthesis, breaks disulfide linkages and reduces OS. It may help to improve pregnancy rates, insulin sensitivity, and metabolic parameters. Additionally, it enhances oocyte quality and supports detoxification. Astaxanthin is a potent antioxidant with anti-inflammatory properties and reduces OS, with the potential to improve the development of follicles and oocytes, insulin sensitivity, lipid parameters, and supports mitochondrial health and cellular function. Melatonin regulates circadian rhythms and reduces OS, helps restore regular menstrual cycles, reduces hyperandrogenism, may improve insulin sensitivity and enhance fertility.
Conclusion:
Antioxidant supplementation may have a complementary role in improving reproductive outcomes in infertile women with PMOS. However, some uncertainty remains given the heterogeneity of the included studies and the limited number of trials for certain antioxidants. Further well-designed randomized controlled studies are required to establish definitive clinical benefit.
