The use of N-Acetyl cysteine versus chromium picolinate as adjuvant to clomiphene citrate and metformin in PCOS women to improve ovulation induction and insulin resistance A pilot randomized controlled trial

Abstract

Background: Good response to ovulation induction and in turn improving pregnancy rates represents a big challenge in patients with PCOS. Aim: To assess the effectiveness of adjuvant therapy to clomiphene citrate and metformin (in the form of N-acetyl cysteine versus Chromium Picolinate) as regards response to ovulation induction and metabolic syndrome improvement in patients with PCOS & infertility. Patients and methods: This randomized controlled trial involved 108 women diagnosed with PCOS and infertility and were divided into 3 groups; according to the treatment protocol; group 1 received clomiphene citrate plus metformin only, group2 received clomiphene citrate and metformin plus N-acetyl cysteine and Group 3 received clomiphene citrate and metformin plus chromium picolinate. Results: There was a statistical significant difference as regards good ovulation in the form of mature follicles (≥18 mm in diameter), with the best results in group 3, followed by group 2. Both N-acetyl cysteine and chromium picolinate, as adjuvant therapies, were more effective in reducing the fasting insulin levels than clomiphene citrate plus metformin alone. Conclusion: Chromium picolinate and N-acetyl cysteine are effective adjuvant therapies for improving ovulation , insulin resistance and endocrinal outcomes in women with PCOS.