N-acetyl cysteine vs. metformin in treatment of clomiphene citrate–resistant polycystic ovary syndrome: a prospective randomized controlled study

Elnashar, Aboubakr; Fahmy, Mohi; Mansour, Ahmad T.; Ibrahim, Karima

doi:10.1016/j.fertnstert.2006.11.173

Cited by 42 publications

(54 citation statements)

References 21 publications

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“…40 In the study by Fulghesu et al wherein, 31 out of 37 women were obese, NAC did not show any significant change in BMI. 6 Similar observation of no significant change in BMI or WHR after six weeks of either NAC or MET was made by Elnashar et al 41 There was significant improvement in mean of parameters of insulin resistance viz fasting blood sugar, fasting insulin, fasting glucose insulin ratio, HOMA-IR and QUICKI in the two groups more in NAC group. All cases of fasting hyperglycemia became euglycemic after Metformin while this change was observed in only 50% cases after NAC.…”

Section: After 3 Months Of Interventionsupporting

confidence: 71%

“…8 On the contrary Elnashar reported significant drop in FPG and serum insulin among patients who received metformin and not in NAC group. 41 Fulghesu, assessing insulin sensitivity using colompe euglycemic hyperinsulinemic technique, showed increased sensitivity to insulin and significant decline in insulin area under curve after oral glucose tolerance test after treatment with NAC while fasting plasma glucose (FPG), fasting insulin and glucose area under the curve remained unchanged. 6 The study showed significant decrease in mean of TG, LDL, VLDL and HDL/LDL ratio with significant increase in HDL within the two groups while not significant among the groups.…”

Section: After 3 Months Of Interventionmentioning

confidence: 99%

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Comparison of metformin and N-acetylcysteine on metabolic parameters in women with polycystic ovarian syndrome

Ali

Radhakrishnan

Singh

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONPolycystic ovary syndrome (PCOS) is a common disease that affects up to 10% of women of reproductive age, in which hyperandrogenism (HA), enlarged cystic ovaries, and chronic anovulation often coexist with obesity, dyslipidemia and insulin resistance (IR).1 The etiology of the syndrome has remained unknown although it has been revealed that IR lies at the core of its pathophysiology. 2,3 Obesity in women with PCOS is rather high, ranging from 30% to 60%, whereas hyperinsulinemia is present in more than 50% of patients with PCOS. 4,5 Furthermore, although about 70% of obese women with PCOS exhibit an exaggerated insulin secretion, this feature is also present in 20%-40% of lean PCOS. [6][7][8] Chronic hyperinsulinemia results in different pathologies such as diabetes mellitus type 2, hypertension, cardiovascular diseases and metabolic syndrome.1,9 Risk factors of cardiovascular diseases tend to accumulate in these women even at their young age and dyslipidemia in these patients is correlated with IR. [10][11][12] It has been proven ABSTRACT Background: Polycystic ovary syndrome (PCOS) is a common disease that affects up to 10% of women of reproductive age, in which hyperandrogenism (HA), enlarged cystic ovaries, and chronic anovulation often co-exist with obesity, dyslipidemia and insulin resistance (IR). There is a need for an alternative to metformin with minimal side effects to improve insulin sensitivity and correct dyslipidemia in PCOS patients. Methods: It was a prospective, Randomized controlled clinical trial. 116 PCOS patients, 58 each in two groups received either Metformin 500 mg TDS or N-acetylcysteine (NAC) 600 mg TDS for 3 months. Clinical and biochemical parameters contributing to metabolic syndrome (MS) and insulin resistance (fasting blood sugar (FBS), fasting insulin (FI), FBS:FI, HOMA-IR and QUICKI) were assessed at the start and end of the study. Results were compared between the two groups. Results: Both treatment modalities resulted in a significant reduction in number of cases with IR (p=0.001) and MS. Fasting hyperinsulinemia improved in 15 % (p=0.12) and 30% (p=0.001) of patients while 12% (p=0.23) and 18% (p=0.049) improvement was seen in FBS:FI in MET and NAC group respectively. Similarly, improvement in HOMA-IR was 12% (p=0.30) and 32% (p=0.001) in MET and NAC group which is significant with NAC. QUICKI and impaired glucose tolerance showed significant improvement in both the groups with a p-value of 0.04 and 0.006, 0.035 and 0.046 respectively. Significant reduction was seen in triglycerides (p=0.048) in NAC group. Conclusions: NAC is equally efficacious as metformin in improving parameters of insulin resistance and metabolic syndrome with minimal occasional side effects ensuring better compliance for a long-term therapy.

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Section: After 3 Months Of Interventionsupporting

confidence: 71%

Section: After 3 Months Of Interventionmentioning

confidence: 99%

Comparison of metformin and N-acetylcysteine on metabolic parameters in women with polycystic ovarian syndrome

Ali

Radhakrishnan

Singh

2017

Int J Reprod Contracept Obstet Gynecol

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“…A study realized on polycystic ovarian syndrome patients, which compared the effect of metformin to those of the association metformin + NAC for short times (5 days), showed NAC is effective in inducing ovulation, even if the number of mature follicles was not significant, as it was confirmed in our experience 23,25 .…”

Section: Resultssupporting

confidence: 68%

“…In vitro studies have produced the complete development from primordial follicle to ovulatory mature follicle just in mice. In humans, the same studies have only produced the maturation from pre-antral to antral stage and from primordial to primary and secondary follicles 25 . The return to gonad functionality on long term ovarian transplantation depends on the survival and growth of the follicles, which itself depends, from the capacity to ovulate 29 .…”

Section: Discussionmentioning

confidence: 99%

N-acetylcysteine improves morphologic and functional aspects of ovarian grafts in rats

et al. 2014

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PURPOSE:To evaluate morphological and functional aspects of the ovarian graft in transplanted rats treated with NAC. METHODS:Female Wistar rats, virgin, 3 to 4 months old, weighing 200-250 grams were used in experiments. The rats have been kept in proper sanitary conditions, receiving food and water ad libitum. Five groups (n=10, each) were constituted: 4 groups treated subcutaneously with NAC, at doses of 150, 300, 600 and 1200 mg/kg (NAC150, NAC300, NAC600 and NAC1200, respectively), one hour of before the ovarian transplantation and control group (GTx) -treated with physiological solution and submitted to ovarian transplantation. The rats were anesthetized and submitted to autologous left ovarian transplantation, without anastomosis in retroperitoneum, and contralateral oophorectomy. During follow-up of 4 or 15 days, the estrous cycle was evaluated by vaginal smears to determine cycle regularity. At the end of 4 th or 15 th days, rats were re-anesthetized and blood and graft were obtained to estradiol analysis and morphological assessment. Data were analysed by One Way Analysis of Variance (ANOVA) or ANOVA on ranks complemented by Student-Newman-Keuls test. RESULTS:At 4 th day, viable follicles in the graft did not altered by NAC treatments. The NAC300 and NAC600 groups showed increasing in follicle atresia (p=0.012) compared to GTx and NAC1200 group. At 15 th day, 50% of GTx, NAC150, and NAC300 rats showed regular oestrous cycle; 83% of NAC600 and 100% of NAC1200 rats returned to regular cycle. NAC1200 group showed increasing in primordial follicle compared to GTx, NAC150 or NAC300 (p=0.011). NAC did not interfere in estradiol levels after 4 or 15 days of transplantation. CONCLUSION:In autologous ovarian transplantation, high dose of NAC promotes graft viability with recovery of estrous cycle.

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“…In the metformin group, the rate of ovulation was 51.6% (16/31) vs. 6.7% (2/30) in the NAC group, which was statistically significant. [16] The authors concluded that metformin alone is an effective drug in inducing ovulation in CC-resistant PCOS, whereas NAC alone is not. [16]…”

Section: Introductionmentioning

confidence: 99%

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

Saha¹,

Kaur²,

Saha³

2013

J Pharmacol Pharmacother

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Clomiphene citrate (CC) has been the gold-standard drug for ovulation induction in polycystic ovary syndrome (PCOS), but still CC resistance is seen in approximately 15-40% in women with PCOS. N-acetyl cysteine (NAC), a safe and cheap drug available in the market many years ago as mucolytic agent, was found to have a role in infertility management. Recently, some reports discussed the possible beneficial effects of NAC on ovulation. The biological properties of the NAC make this drug a potential candidate for its use in the infertility treatment, especially in the PCOS in inducing or augmenting ovulation. An updated electronic search was performed through PUBMED, MEDLINE, and COCHRANE and focused on peer-reviewed, full text, randomized controlled trials, and observational cohort or case-control studies for role of NAC in CC-resistant PCOS. Thorough search through all the clinical studies showed mixed results. Studies with positive results showed improvement in induction of ovulation as compared to negative studies showing contrary results. More randomized clinical trials are still needed to establish its definitive role in CC-resistant PCOS.

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N-acetyl cysteine vs. metformin in treatment of clomiphene citrate–resistant polycystic ovary syndrome: a prospective randomized controlled study

Cited by 42 publications

References 21 publications

Comparison of metformin and N-acetylcysteine on metabolic parameters in women with polycystic ovarian syndrome

Comparison of metformin and N-acetylcysteine on metabolic parameters in women with polycystic ovarian syndrome

N-acetylcysteine improves morphologic and functional aspects of ovarian grafts in rats

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

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