title: Adding L-carnitine to clomiphene resistant PCOS women improves the quality of ovulation and the pregnancy rate. A randomized clinical trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of L-carnitine on improving the ovulation and pregnancy rates as well as adverse metabolic indices in clomiphene-resistant PCOS.
  
  
  METHODS
  Single center, double blinded, superiority, randomized controlled clinical trial.
  
  
  METHODS
  Women's Health Hospital, Assiut University.
  
  
  METHODS
  One hundred and seventy women diagnosed with PCOS were found to be clomiphene resistant. The women were randomly allocated into two groups: Group A (n=85), where patients received 250 mg clomiphene citrate from day three until day seven of the cycle plus L-carnitine (LC) 3g daily; and Group B (n=85) received 250 mg clomiphene citrate with placebo.
  
  
  RESULTS
  Primary outcome is cumulative clinical pregnancy rate. Secondary outcomes are changes in serum glucose level and lipid profile.
  
  
  RESULTS
  The combination of L-carnitine and CC significantly improve both the ovulation and the cumulative pregnancy rates in clomiphene resistant PCOS (55 (64.4%) vs. 15 (17.4%) and 44 (51.5) % vs. 5 (5.8) %). The number of stimulated follicles reaching ≥17 mm diameter was significantly more in Group A to Group B (2.2 ± 0.77 vs. 0.16 ± 0.79; p<0.0001). Group A needed significantly fewer days for adequate follicular maturation, had a thicker endometrium and higher oestradiol concentration at the time of human chorionic gonadotrophin injection (10.1 ± 0.1mm vs. 6.8 ± 0.4mm; p<0.0001). The same group had a higher mean luteal-phase serum progesterone compared with the control group (13.55 ± 0.99 vs. 10.6 ± 0.98 ng; p<0.0001). A significant difference was found regarding the clinical pregnancy rates (42 (49.4%) vs. (1) 1.1% respectively p value <0.0001).
  
  
  CONCLUSIONS
  Adding L-carnitine when treating clomiphene-resistant PCOS patients not only improved the quality of ovulation and the pregnancy rate with an acceptable patient tolerability, but also enhanced the patient lipid profile and body mass index.
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Egypt.
authors.forename: Alaa M
authors.initials: AM
authors.lastname: Ismail
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Egypt. Electronic address: aliamr22@hotmail.com.
authors.forename: Ali Hassan
authors.initials: AH
authors.lastname: Hamed
authors.affiliation: Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, UK.
authors.forename: Srdjan
authors.initials: S
authors.lastname: Saso
authors.affiliation: Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Egypt.
authors.forename: Hossam H
authors.initials: HH
authors.lastname: Thabet
mesh_terms: D000328:Adult; D002331:Carnitine / Q000627:therapeutic use*; D002996:Clomiphene / Q000627:therapeutic use*; D004311:Double-Blind Method; D004351:Drug Resistance; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D007986:Luteinizing Hormone / Q000097:blood; D010060:Ovulation; D010062:Ovulation Induction / Q000379:methods; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D005300:Fertility Agents, Female; D014803:Vitamin B Complex; D002996:Clomiphene; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D002331:Carnitine
keywords: Induction of ovulation; Oxidative stress; PCOS; l-carnitine