N-acetylcysteine as an adjuvant to clomiphene citrate for successful induction of ovulation in infertile patients with polycystic ovary syndrome

Aim: The aim of this study was to evaluate the effect of oral N-acetylcysteine (NAC) administration as an adjuvant to clomiphene citrate (CC) on induction of ovulation outcomes in patients with polycystic ovary syndrome (PCOS). Material and Methods: In this placebo-controlled double-blind randomized clinical trial, 180 PCOS infertile patients were randomly divided into two groups for induction of ovulation. Patients in group 1 received CC 100?mg/d plus NAC 1.2?g/d and patients in group 2 received CC plus placebo for 5?days 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 18-20-mm diameter in ultrasound evaluation, 10?000?U hCG was injected intramuscularly and timed intercourse was advised 36?h after hCG injection. Serum β-hCG level was measured on the 16th day after hCG injection. Results: The number of follicles >18?mm 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 0.04, respectively). No adverse side-effects and no cases of ovarian hyperstimulation syndrome were observed in the group receiving NAC. Conclusion: NAC as a safe and well-tolerated adjuvant to CC for induction of ovulation can improve the ovulation and pregnancy rates in PCOS patients. It may also have some beneficial impacts on endometrial thickness.