Does inositol ratio orchestrate the fate of ovarian follicles?

The ratio of myo-inositol (MI) to d-chiro-inositol (DCI) seems to regulate the steroidogenesis in recruited follicles. While MI favors the increase of estrogens, DCI contributes to an androgenic environment, either by stimulating the biosynthesis of testosterone or by reducing its conversion to estradiol. Based on available evidence, we put forward the hypothesis that the different MI:DCI ratios influence the selection process, determining the dominant follicle and the follicles that will undergo atresia. We also suggest that the MI:DCI ratio may be regulated by follicles' intrinsic characteristics, which possibly drive the cohort recruitment at each ovarian cycle.