EFFECT OF N-ACETYLCYSTEINE AS AN ADJUVANT TO CLOMIPHENE CITRATE FOR INDUCTION OF OVULATION IN PATIENTS WITH POLYCYSTIC OVARY SYNDROME

Mofeed F. Mohammad*, Yahia A. Wafa and Mohammad A. Haider

ABSTRACT

Objective: The aim of this study was to evaluate the effect of oral N-acetyl cysteine (NAC) administration as an adjuvant to clomiphene citrate (CC) on induction of ovulation outcomes in patients with polycystic ovary syndrome (PCOS). Patient and Methods: In this placebo-controlled double-blind randomized clinical trial, 200 PCOS infertile patients were randomly divided into two groups for induction of ovulation. Patients in group 1 received CC 100 mg/d plus NAC 1.2 g/d and patients in group 2 received CC plus placebo for 5 days starting at day 3 of the cycle. On the 12th day of the menstrual cycle in the presence of at least one follicle with an 18–20-mm diameter in ultrasound evaluation, 10 000 U hCG was injected intramuscularly and timed intercourse was advised 36 h after hCG injection. Serum b-hCG level was measured on the 16th day after hCG injection. Results: The number of follicles >18 mm on the day of hCG administration and ovulation rates were significantly higher among the CC+NAC group(P-value˂0.0001). The mean endometrial thickness and pregnancy rate were also significantly higher in the CC+NAC group (P-value=0.022 and 0.002, respectively). No adverse side-effects and no cases of ovarian hyperstimulation syndrome were observed in the group receiving NAC. Conclusion: NAC as an adjuvant to CC for induction of ovulation can improve the ovulation and pregnancy rates in PCOS patients and may also have some beneficial impacts on endometrial thickness. NAC is well-tolerated, safe and inexpensive and may be a novel adjuvant treatment to improve the induction of ovulation outcomes in PCOS patients. It could be used an alternative to other insulin-sensitizing agents like metformin or troglitazone.

Keywords: clomiphene citrate, N-acetylcysteine, ovulation, polycystic ovary syndrome, pregnancy rate.