Objective To compare clinical and metabolic profiles between N‐acetylcysteine and l‐carnitine among women with clomiphene citrate (CC)‐resistant polycystic ovary syndrome (PCOS). Methods A randomized trial at Zagazig University between January 2017 and March 2018. Women with CC‐resistant PCOS were allocated randomly to receive CC plus N‐acetylcysteine or CC plus l‐carnitine. The primary outcome was clinical pregnancy rate; secondary outcomes were ovulation rate and metabolic changes. Results Overall, 162 women completed the study (N‐acetylcysteine group, n=82; l‐carnitine group, n=80). After 3 months, there was no difference in pregnancy (P=0.15), ovulation (P=0.21), or spontaneous abortion (P=0.11) rates between the two groups. There was no significant decrease in BMI in either group (both P>0.05). There were improvements in menstrual pattern, follicle‐stimulating hormone, luteinizing hormone, free testosterone, and insulin resistance markers in both groups (all P<0.05). An improvement in lipid profile was observed only in the l‐carnitine group (P<0.001). N‐Acetylcysteine treatment led to significantly greater improvement in free testosterone and insulin resistance parameters as compared with l‐carnitine (all P<0.05). Conclusions Both N‐acetylcysteine and l‐carnitine were equally effective in improving pregnancy and ovulation rates among women with CC‐resistant PCOS. However, N‐acetylcysteine was superior in ameliorating insulin resistance and only l‐carnitine improved lipid profile. Trial Registration: ClinicalTrials.gov: NCT03164421.

Background: Relieving postoperative pain and prompt resumption of physical activity are of the utmost importance for the patients and surgeons. Infiltration of local anesthetic is frequently used methods of pain control postoperatively. Laparoscopically delivered transversus abdominis plane block is a new modification of ultrasound-guided transversus abdominis plane block. This study was conducted to compare the efficacy of laparoscopic-guided transversus abdominis plane block with trocar site local anesthetic infiltration for pain control after gynecologic laparoscopy. Results: No statistically significant difference between the two groups in mean visual analogue scale at 1, 18, and 24 h (P = 0.34, P = 0.41, and P = 0.61, respectively), while the mean visual analogue scale was significantly lower in the laparoscopic-guided transversus abdominis plane block group than in the trocar site local anesthetic infiltration group at 3, 6, and 12 h (P = 0.049, P = 0.011, and P = 0.042, respectively). No statistically significant difference was observed in the cumulative narcotics consumed at 3 h (P = 0.52); however, women with transversus abdominis plane block have consumed significantly less amount of narcotics than women with trocar site infiltration at 6, 12, and 24 h (P = 0.04, P = 0.038, and P = 0.031 respectively). Patient satisfaction was significantly higher in the laparoscopic-guided transversus abdominis plane block group (P = 0.035). Conclusion: Laparoscopic-guided transversus abdominis plane block is more effective in reduction of both pain scores in the early postoperative period and the cumulative narcotics consumption than trocar site local anesthetic infiltration in gynecologic laparoscopy.