N -acetyl cysteine in clomiphene citrate resistant polycystic ovary syndrome: A review of reported outcomes

Saha, Lekha; Kaur, Sharonjeet; Saha, Pradip Kumar

doi:10.4103/0976-500x.114597

Cited by 19 publications

(14 citation statements)

References 15 publications

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“…The superiority of metformin+clomiphene over NAC+clomiphene in terms of ovulation and pregnancy was demonstrated in one RCT . A recent review of clinical studies of the results of NAC for the induction of ovulation in CCR‐PCOS women showed both positive and negative results .…”

Section: Discussionmentioning

confidence: 98%

Combined metformin‐clomiphene in clomiphene‐resistant polycystic ovary syndrome: a systematic review and meta‐analysis of randomized controlled trials

Hashim

Foda

Ghayaty

2015

Acta Obstet Gynecol Scand

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Section: Discussionmentioning

confidence: 98%

Combined metformin‐clomiphene in clomiphene‐resistant polycystic ovary syndrome: a systematic review and meta‐analysis of randomized controlled trials

Hashim

Foda

Ghayaty

2015

Acta Obstet Gynecol Scand

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“…12 Many studies tried to combine another drug to CC to increase its efficacy. 13 Others replaced it by an alternative medical or surgical treatment. Gonadotrophins therapy (GTs) is considered the best second line as it doesn't affect ovarian reserve and carries no risks of peritubal or periovarian adhesions.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic ovarian drilling-plus: a one-stop management approach for PCO-associated infertility

Darwish

Kamel

Othman

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONPolycystic ovarian syndrome (PCOS) is the commonest hyperandrogenic disorder in women and one of the most common causes of anovulatory infertility, with an estimated prevalence of 4-7% worldwide. 1 It is an overdiagnosed and disproportionately treated condition.Lifestyle modification, weight loss, and exercise form the first line of treatment in infertile women with PCOS. 2The recommended first-line drug for ovulation induction remains clomiphene citrate (CC), while metformin is helpful in cases with glucose intolerance, or those with a BMI >35 kg/m. 3 ABSTRACT Background:The current study aims to estimate additional values of laparoscopic intervention for diagnosis and treatment of concomitant pelvic pathologies among infertile women with clomiphene-resistant polycystic ovarian syndrome (PCOS) subjected to laparoscopic ovarian drilling (LOD) in comparison to non-PCOS infertile women subjected to diagnostic/therapeutic laparoscopy. Methods: A prospective cross sectional observational study was carried out in the Endoscopic unit of a tertiary care university hospital. The study included 232 infertile women planned for laparoscopy were divided into a study group A (116 cases) with clomiphene-resistant PCOS and a control group B (116 cases) without PCOS. Each group was further subdivided into two subgroups according to the presence and absence of risk factors (RF) for adhesion formation. Diagnostic/operative laparoscopy was done. The main study outcome was the prevalence of any pelvic abnormalities seen during laparoscopy. Results: Both groups showed insignificant difference regarding socio-demographic history and basic data. Laparoscopy detected pelvic pathologies in 44 cases (37.9%) and 86 cases (74.1%) in both groups respectively. In group A, we diagnosed pelvic pathologies in 29 (32.6%) and 15 (55.6%) cases with and without RF respectively while in group B they were diagnosed in 76 (84.4%) and 10 (38.5%) cases with and without RF respectively. If compared to women with unexplained infertility, PCO patients without risk factors have an insignificant but higher prevalence of pelvic abnormalities. All concomitant pelvic pathologies in both groups were treated on a one-stop (see and treat) basis. Conclusions: Detection and proper management of associated pelvic pathologies at laparoscopy is a valuable additional advantage of LOD particularly in women with positive risk factors. LOD plus see and treat associated pathologies is a time saving and prompt management approach for women with PCO-associated infertility.

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“…Second-line treatments for infertile women with CCR-PCOS include gonadotrophins, laparoscopic ovarian diathermy (LOD) and other oral agents, such as aromatase inhibitors, N-acetylcysteine (NAC), and other insulin sensitizers (Abu Hashim et al, 2013;ESHRE/ASRM, 2008;Franik et al, 2014;Saha et al, 2013;Tang et al, 2012). Although many RCT have investigated the efficacy of metformin plus different second-line treatment options in CCR-PCOS patients, only two RCT compared metformin monotherapy with LOD with conflicting results.…”

Section: Metformin Plus Clomiphene Citrate Versus Other Second-line Tmentioning

confidence: 99%

Twenty years of ovulation induction with metformin for PCOS; what is the best available evidence?

Hashim

2016

Reproductive BioMedicine Online

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The potential reproductive benefits of metformin, a drug endowed with the capacity to ameliorate insulin resistance in polycystic ovary syndrome (PCOS), has garnered much interest over the past 2 decades. In this review, randomized-controlled trials (RCT) and meta-analyses of RCT comparing metformin are critically appraised and summarized. PubMed and CENTRAL databases were consulted. Evidence is insufficient to favour the use of metformin or metformin plus clomiphene citrate instead of clomiphene citrate for ovulation induction in women with newly diagnosed PCOS. Evidence is also insufficient to recommend metformin as a primary treatment for non-obese women with PCOS. Metformin plus clomiphene citrate should be considered as an effective option in clomiphene citrate-resistant PCOS. In women with PCOS undergoing gonadotrophin ovulation induction, metformin significantly increased pregnancy and live birth rates (P< 0.0001 and P = 0.020, respectively) with reduced risk of cancelled cycles. A beneficial effect of metformin co-treatment in increasing clinical pregnancy rates and reducing the risk of OHSS in PCOS patients undergoing assisted reproduction techniques has been shown. No evidence was found of reduced risk of spontaneous abortion or increased risk of major anomalies in women with PCOS taking metformin during the first trimester.

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N -acetyl cysteine in clomiphene citrate resistant polycystic ovary syndrome: A review of reported outcomes

Cited by 19 publications

References 15 publications

Combined metformin‐clomiphene in clomiphene‐resistant polycystic ovary syndrome: a systematic review and meta‐analysis of randomized controlled trials

Combined metformin‐clomiphene in clomiphene‐resistant polycystic ovary syndrome: a systematic review and meta‐analysis of randomized controlled trials

Laparoscopic ovarian drilling-plus: a one-stop management approach for PCO-associated infertility

Twenty years of ovulation induction with metformin for PCOS; what is the best available evidence?

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