P-612 Current understanding of polycystic ovary syndrome (PCOS) and potential interest in future trial to evaluate role of myo-inositol as ovulation induction agent – Stakeholder’s surveys
Authors: Pundir J , Dimitriou E , Thangaratinam S 
Published: June 2022

Abstract

Study question
To assess awareness amongst consumers and gynaecologists on various aspects of PCOS and to explore the willingness to participate in a future trial of myo-inositol as an ovulation induction agent.

Summary answer
Significant lack of awareness on various aspect of PCOS amongst consumers is concerning. Gynaecologists and consumers are keen on trial exploring myo-inositol in anovulatory PCOS.

What is known already
Initial studies have reported that Myo-inositol can increase the frequency of menstruation and ovulation along with benefit with androgenic and glycaemic parameters in women with PCOS. There is a need for large, well designed and powered randomised controlled trial to evaluate the role of Myo-inositol as a fertility enhancing agent on its own and as an adjunct to clomiphene/letrozole in women with anovulatory PCOS. There has been a growing interest in patient and public involvement in setting research priorities to reduce the risk of discrepancy between what stakeholder’s experience as important unanswered questions and those which are actually researched.

Study design, size, duration
The surveys were hosted using on-line survey tool (www.surveymonkey.com) between Dec 2020 and April 2021, in the UK. Bespoke questionnaires were designed for the survey of gynaecologists (comprising of 27 questions) and the women with PCOS (comprising of 20 questions). These were peer reviewed and included, multiple choice questions, questions with a Likert scale response and open format questions. Ethical approval was provided by Queen Mary University of London (QMUL) ethics committee (Ref: QMERC2014/76).

Participants/materials, setting, methods
The online clinician survey was a cross sectional study of gynaecologists who look after women with PCOS, and the consumer survey was a cross sectional study of the members of PCOS support organisation “Verity”. The data was collected using on-line survey tool and was summarised descriptively using numbers and percentages. For the descriptive statistics, we used absolute and relative frequencies, and we also used the median and the IQR to detect the most common answers.

Main results and the role of chance
There were 244 responses; 104 gynaecologists and 140 consumers.
Majority of the consumers were aware that, women with PCOS struggle with irregular cycles (94%); to loss/maintain weight (83%); and to conceive (85%). 81% were aware of risk of subfertility, however, only half were aware of risks associated with irregular menstrual cycles (51%), gestational diabetes (57%) and long-term risks such as diabetes (62%). 96% felt subfertility was an important issue, however, only 2/5th were aware of treatment options, a third were aware of need for USS monitoring whilst taking clomid tablets and that clomid tablets can only be used for 6-12 cycles.
The clinician survey showed that 70% of the gynaecologists chose life-style measurements for the first line option and the second line options were 35% for clomiphene, 29% for clomiphene + metformin, followed by 21% for letrozole. 79% use USS to confirm ovulation and 60% by measuring serum progesterone; 37% monitor all cycles of ovulation induction whereas 41% monitor index cycle.
Two thirds of the gynaecologists (72%) and majority of consumers (88%) agreed on the need to research myo-inositol for ovulation induction in PCOS and were willing to participate in such a study. Barriers for recruitment and retention were also explored.

Limitations, reasons for caution
Clinician survey was unable to get the views of general practitioners and endocrinologists, who might have a different perspective particularly on non-reproductive outcomes. Consumer survey was online survey in English which can result in a selection bias and the views of women from other socio-economic and cultural backgrounds may differ.

Wider implications of the findings
These surveys provide vital information in planning a definitive RCT on the role of myo-inositol in women with anovulatory PCOS trying to conceive. Further research tools need to be explored to provide better information and education to the women with PCOS particularly on the long-term risks associated with PCOS.

Trial registration number
NA