Oxidative Stress in Polycystic Ovarian Syndrome and the Effect of Antioxidant N-Acetylcysteine on Ovulation and Pregnancy Rate

Abstract

Polycystic ovarian syndrome (PCOS) is an endocrinological condition that leads to infertility in many females. N-acetylcysteine (NAC), a novel antioxidant, is being used as an adjuvant to treat infertility in females suffering from PCOS. This review aims to evaluate oxidative stress in females suffering from PCOS and assess whether the anti-oxidizing properties of NAC are beneficial in enhancing the rate of ovulation and pregnancy in infertile PCOS females. A literature search was conducted manually on PubMed and Google Scholar databases using the following keywords: "N-Acetylcysteine," "PCOS," "Oxidative stress," "Antioxidants," and "infertility" alone and/or in combination for data collection. The studies were manually screened and, after applying inclusion-exclusion criteria, 32 studies consisting of 2466 females of the reproductive age group are included in this review. Our review revealed that females suffering from PCOS tend to show elevated levels of inflammatory markers and a decrease in antioxidant capacity. When used in combination with clomiphene citrate or letrozole, NAC increases ovulation and pregnancy rate in infertile females suffering from PCOS and positively affects the quality of oocytes and number of follicles ≥18mm. Moreover, its side effect profile is low. It also results in a mild increase in endometrial thickness in some females. Future studies on a large sample size using NAC alone are highly recommended to evaluate its role as a single-drug therapy for treating infertility in females suffering from PCOS.

N-Acetylcysteine in Mechanically Ventilated Rats with Lipopolysaccharide-Induced Acute Respiratory Distress Syndrome: The Effect of Intravenous Dose on Oxidative Damage and Inflammation

“…GSH as a direct antioxidant regulates the oxidation state in cells and at the same time acts as a substrate for several antioxidant enzymes [ 35 ]. The elucidation of the role of oxidative stress in the pathogenesis of many diseases has led to experimental or clinical use of NAC in several respiratory diseases, including chronic obstructive pulmonary disease [ 36 ], idiopathic pulmonary fibrosis [ 37 ], or pulmonary silicosis [ 38 ], as well as in variety of cardiovascular diseases [ 39 , 40 ], chronic nephropathy [ 41 ], or infertility [ 42 ]. In this model, intratracheal LPS, increased oxidative damage of lipids and proteins in lung tissue in accordance to other studies.…”

Modulation of the Inflammatory Response in Polycystic Ovary Syndrome (PCOS)—Searching for Epigenetic Factors

“…It has been established that mtDNA transcription is accompanied by decreased in vivo methylation, whereas inducing mtDNA replication leads to increased methylation. However, the crucial phenomenon is the modulation of mtDNA methylation in response to oxidative stress because it may be clearly linked to mitochondrial dysfunction in PCOS correlated with elevated levels of inflammatory markers and a decrease in antioxidant capacity [ 99 , 103 , 104 ].…”

Effects of N-acetylcysteine and metformin treatment on the stereopathological characteristics of uterus and ovary

“…Therefore, NAC can have positive effects on ovulation in PCOS patients. 11 NAC can effectively strengthen pregnancy and ovulation rates. It is safe with a high lethal dose threshold, resulting in no side effects.…”