N-acetyl cysteine vs. metformin in treatment of clomiphene citrate-resistant polycystic ovary syndrome: a prospective randomized controlled study.
OBJECTIVE
To compare the effect of N-acetyl cysteine and metformin on hormonal profile (insulin and T) and ovulation rate in women with clomiphene citrate-resistant polycystic ovary syndrome.


METHODS
Prospective randomized controlled study.


METHODS
Department of obstetrics and gynecology in a university hospital in Egypt.


METHODS
Sixty-one infertile women with clomiphene citrate-resistant polycystic ovary syndrome were assigned randomly to receive either metformin (1,500 mg/d) or N-acetyl cysteine (1.8 g/d) for 6 weeks.


METHODS
Hormonal profile was determined before and after the course of treatment. Folliculometry was performed to assess ovulation.


METHODS
Ovulation rate and insulin and T changes.


RESULTS
In the metformin group, there was a significant decrease in the fasting glucose, fasting insulin, and total T. In the N-acetyl cysteine group, there was no significant difference in the fasting glucose or fasting insulin and there was a significant decrease in total T. There was no significant difference in the fasting glucose-fasting insulin ratio in both groups. In the metformin group, the rate of ovulation was 51.6% (16/31), vs. 6.7% (2/30) in the N-acetyl cysteine group, which was statistically significant.


CONCLUSIONS
Metformin alone is an effective drug in inducing ovulation in clomiphene citrate-resistant polycystic ovary syndrome, whereas N-acetyl cysteine alone is not. Further large studies are required to confirm our results.
Elnashar
Aboubakr
A
Department of Obstetrics and Gynecology, Benha University Hospital, Benha, Egypt. elnashar53@hotmail.com <elnashar53@hotmail.com>
Fahmy
Mohi
M
Mansour
Ahmad
A
Ibrahim
Karima
K
D000111:Acetylcysteine / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002996:Clomiphene / Q000627:therapeutic use*; D004351:Drug Resistance / Q000187:drug effects; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008687:Metformin / Q000627:therapeutic use*; D010060:Ovulation / Q000187:drug effects; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000188:drug therapy*; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D013739:Testosterone / Q000097:blood; D017211:Treatment Failure
D001786:Blood Glucose; D007328:Insulin; D020845:Selective Estrogen Receptor Modulators; D002996:Clomiphene; D013739:Testosterone; D008687:Metformin; D000111:Acetylcysteine