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Combination of oral myo-inositol and probiotics remarkably shifts the vaginal microbiome toward fertility-favorable community state types profiles.
In accordance with the outcomes of a randomized controlled trial, oral myo-inositol combined with a multi-strain probiotic blend can shift the vaginal microbiome towards fertility-friendly community state types (CSTs), offering a non-invasive reproductive health strategy.
This prospective, single-center, open-label study recruited 150 healthy women (aged 18–45 years) with regular cycles. Volunteers were randomized (1:1) to receive either a daily nutraceutical formulation—containing myo-inositol 4 g, folic acid 0.4 mg, melatonin 1.8 mg, vitamin D 2,000 IU, zinc 10 mg, and a five-strain probiotic blend (5×10⁹ colony-forming unit)—or no treatment for one menstrual cycle. Vaginal microbiome composition was analyzed using 16S rRNA sequencing, with CST classification and statistical comparisons of microbial diversity and transitions.
Among 148 subjects who completed the study, supplementation led to a remarkable improvement in CST distribution, with 28.6% of women showing resolution of CST-IV to favorable CST I–III profiles, compared with no such transitions in controls (p<0.05). Overall, favorable microbiome shifts occurred higher in treatment group vs. control group (Table 1).
The intervention also elicited meaningful microbial changes, including a reduction in α-diversity in those with high baseline richness, suggesting improved microbiome stability. In CST-IV participants, Lactobacillus abundance increased markedly from 7% to 30%, while remaining unchanged in controls. At the same time, Atopobium—linked with poorer fertility outcomes—declined considerably, and Lactobacillus crispatus elevated across non-dominant CSTs.
Functional analysis further revealed modulation of arginine–ornithine–putrescine metabolic pathways, which are linked to vaginal dysbiosis. Notably, vaginal pH remained unchanged, and the formulation was well-tolerated, with only 3 mild adverse events reported. Thus, short-term use of myo-inositol–probiotic nutraceutical successfully shifts the vaginal microbiome toward fertility-supportive profiles, particularly in women with dysbiosis (CST-IV/V), supporting its potential as a safe, non-invasive fertility-enhancing approach.
Fertility and Sterility
EFFECT OF A NUTRACEUTICAL BASED ON MYO-INOSITOL AND MULTI-STRAIN PROBIOTICS ON VAGINAL MICROBIOME MODULATION AND REPRODUCTIVE PROGNOSIS IN HEALTHY WOMEN: INOBIOTIC RANDOMIZED CLINICAL TRIAL
Julia Ramos et al.
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