Abstract

Background: Polyendocrine metabolic ovary syndrome (PMOS) is the most common endocrine disorder affecting women of reproductive age and represents a leading cause of anovulatory infertility. Beyond reproductive dysfunction, PMOS is characterized by insulin resistance, oxidative stress, chronic low- grade inflammation, and hyperandrogenism, all of which contribute to impaired folliculogenesis and reduced fertility. Celine® is a nutraceutical formulation combining myo-inositol, alpha-lipoic acid, and N-acetylcysteine, three compounds with complementary insulin-sensitizing and antioxidant properties. Several clinical studies have evaluated its use in different PMOS populations; however, the available evidence has not previously been synthesized into a single comprehensive review. Objective: To integrate and critically evaluate the published clinical evidence on Celine® across different stages of PMOS management, including metabolic control, restoration of ovulation, and assisted reproductive technology (ART) outcomes. Methods: A narrative integrated evidence review was performed using all three currently published clinical studies evaluating Celine® in women with PMOS. Three clinical investigations involving approximately 1,000 women were included: two randomized controlled trials and one prospective chart review. Evidence was synthesized descriptively according to major clinical outcome domains rather than statistically pooled because of differences in study design, patient populations, interventions, comparators, and outcome definitions. Results: Across all included studies, Celine®-containing regimens consistently demonstrated favorable effects on reproductive and metabolic outcomes. Reported benefits included improvements in insulin resistance and glycemic control, menstrual regularity, ovulation, pregnancy rates, follicular development, mature oocyte yield, embryo quality, and ovarian stimulation efficiency during ART. Although outcome measures were heterogeneous and therefore unsuitable for formal meta-analysis, the consistency of effect direction across complementary clinical settings supports the biological plausibility of the intervention and suggests potential benefits throughout the continuum of PMOS management. Conclusions: The currently available evidence indicates that Celine® may represent a promising adjunctive therapeutic strategy for women with PMOS by simultaneously targeting the metabolic disturbances and reproductive dysfunction underlying the disorder. While the consistency of findings across the available studies is encouraging, the evidence remains limited by heterogeneous study designs and the absence of independent replication. Additional multicenter, adequately powered randomized controlled trials are required to confirm these findings, establish long-term reproductive outcomes, and define the optimal place of Celine® within contemporary PMOS management.