Efficacy of N Acetylcysteine as an adjunct to Clomipene citrate in induction of ovulation in Anovulatory Infertility

Objective: N-acetyl-cysteine (NAC), a mucolytic drug with insulin sensitizing properties, has been proved useful as an adjuvant therapy in subjects with infertility due to anovulation associated with polycystic ovarian syndrome The objective of the present study is to determine the possible beneficial effect of NAC and to develop a rationale to its use in such cases as an adjunct to clomiphene citrate (CC) which remains the gold standard for ovulation induction. Material and Methods: In this placebo-controlled clinical study, 90 patients with anovulatory PCOS related infertility were randomly divided into two groups for induction of ovulation. Patients in group 1 received CC 50/day for 5 days plus NAC 1.2g/d and patients in group 2 received CC only for 5days starting at day 3 of the cycle. On the 12th day of the menstrual cycle in the presence of at least one follicle with an 18 diameter in ultrasound evaluation, 5000U hCG was injected intramuscularly and timed intercourse was advised 36h after hCG injection. Serum β-hCG level was measured on the 16th day after hCG injection. Results: The number of follicles >18mm and the mean endometrial thickness on the day of hCG administration were significantly higher among the CC+NAC group (P-value=0.001). The ovulation and pregnancy rates were also significantly higher in the CC+NAC group (P-value=0.02 and 0.001, respectively). No adverse side-effects and no cases of ovarian hyperstimulation syndrome were observed in the group receiving NAC. Conclusion: NAC as an adjuvant to CC for induction of ovulation can improve the ovulation and pregnancy rates in PCOS patients and may also have some beneficial impacts on endometrial thickness. NAC is well-tolerated, safe, and inexpensive and may be a novel adjuvant treatment to improve the induction of ovulation outcomes in PCOS patients.