Restricted accessResearch articleFirst published online 2010-11
N-Acetyl Cysteine Plus Clomiphene Citrate Versus Metformin and Clomiphene Citrate in Treatment of Clomiphene-Resistant Polycystic Ovary Syndrome: A Randomized Controlled Trial
To compare the effects of combined N-acetyl cysteine (NAC) and clomiphene citrate (CC) and of combined metformin and CC on ovulation induction in anovulatory CC-resistant women with polycystic ovary syndrome (PCOS).
Methods:
One hundred ninety-two women were randomized to receive either the NAC-CC drug combination (group A, n = 95) or the combined metformin-CC therapy (group B, n = 97) for three treatment cycles. The primary outcome measure was ovulation; secondary outcomes were number of follicles, serum estrogen and progesterone levels, posttreatment endometrial thickness, pregnancy, and miscarriage.
Results:
Over a 3-month follow-up period, women in group B had significantly higher ovulation and pregnancy rates compared with women in group A (69.1% vs. 20.0%, p = 0.002, and 22.7% vs. 5.3%, p = 0.020, respectively). The level of serum estrogen, the endometrial thickness on the day of human chorionic gonadotropin (hCG) administration, and the serum progesterone level on cycle days 21–23 were all significantly higher for women in group B than for those in group A. Additionally, a lower miscarriage rate was observed among women in group B than among those in group A.
Conclusions:
The efficacy of metformin-CC combination therapy is higher than that of NAC-CC for inducing ovulation and achieving pregnancy among CC-resistant PCOS patients.
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