OVULATION INDUCTION USING CLOMIPHENE CITRATE COMBINED WITH N ACETYLCYSTEINE IN POLYCYSTIC OVARY SYNDROME
Obstetrics & Gynecology Department, Faculty of Medicine, Benha University
Aim: The objective of this work was to assess the impact of adding oral N-acetyl cysteine (NAC) to clomiphene citrate (CC) on ovulation induction outcomes in women diagnosed with polycystic ovary syndrome (PCOS). Material and Methods: In this controlled clinical trial was ccarried out between June 2013 and August 2015.Patients were carefully chosen from the outpatient clinic of obstetrics and gynecology at Benha University Hospital in addition to private centers. 113 infertile women with PCOS were evaluated for eligability; 13 patient were excluded (they did not give approval consent). 100 PCOS infertile females were randomly recruited then divided into two equal groups for induction of ovulation. 50 women in group I (CC+NAC) received CC 50 mg/b.i.d. combined with NAC 1200 mg/d while patients in group II (CC only) received CC alone for 5 days starting day 3 of their menstrual cycle.On the twelfth day of the menstrual cycle within apperance of at least one follicle measured (18–20-mm) by ultrasound examination, 10 000 U hCG was given intramuscularly, and scheduled intercourse was encouraged 36 h after hCG therapy. Outcome measures included the number of mature follicles, serum E2 and serum progesterone levels, in addition to the endometrial thickness. The development of clinical pregnancy was also analyzd and compared between the groups. Results: The number of follicles (>18 mm) on the day of hCG therapy and ovulation rates showed signiﬁcant rise in the CC+NAC group (P-value˂0. 001). The mean endometrial thickness and pregnancy rate were also significantly increased in the CC+NAC group (P-value=0.024 and 0.002, respectively). No adverse events were reported and no cases of ovarian hyperstimulation syndrome were seen among the patients receiving NAC. Conclusion: NAC as an adjuvant to CC for induction of ovulation that may enhance ovulation and pregnancy rates in PCOS with some helpful effect on endometrial thickness. NAC is safe, well-tolerated, and relatively inexpensive primary adjuvant treatment to boost the ovulation and pregnancy outcomes in PCOS patients.