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Current Women`s Health Reviews

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ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

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Research Article

The Use of N-Acetyl Cysteine Versus Chromium Picolinate as an Adjuvant to Clomiphene Citrate and Metformin in PCOS Women to Improve Ovulation Induction and Insulin Resistance: A Pilot Randomized Controlled Trial

Author(s): Mahmoud Alalfy*, Ahmed S. S. A. Rashwan, Mohamed Hussein, Ahmed Bakry , Ahmed Eid and Marwa M. Eid

Volume 18, Issue 2, 2022

Published on: 10 March, 2021

Article ID: e241221192204 Pages: 7

DOI: 10.2174/1573404817666210310164353

Price: $65

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 and infertility.

Materials 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 statistically 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 Nacetyl 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.

Keywords: PCOS, ovulation, chromium, N-acetyl cysteine, infertility, metformin.

Graphical Abstract

[1]
Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004; 89(6): 2745-9.
[http://dx.doi.org/10.1210/jc.2003-032046] [PMID: 15181052]
[2]
Balen A. The pathophysiology of polycystic ovary syndrome: trying to understand PCOS and its endocrinology. Best Pract Res Clin Obstet Gynaecol 2004; 18(5): 685-706.
[http://dx.doi.org/10.1016/j.bpobgyn.2004.05.004] [PMID: 15380141]
[3]
Rolland AL, Peigné M, Plouvier P, Dumont A, Catteau-Jonard S, Dewailly D. Could myo-inositol soft gel capsules outperform clomiphene in inducing ovulation? Results of a pilot study. Eur Rev Med Pharmacol Sci 2017; 21(2)(Suppl.): 10-4.
[PMID: 28724178]
[4]
Badawy A, Elnashar A. Treatment options for polycystic ovary syndrome. Int J Womens Health 2011; 3: 25-35.
[http://dx.doi.org/10.2147/IJWH.S11304] [PMID: 21339935]
[5]
EL-Gharib MN, Osman AM. N-Acetyl cysteine, chromium picolinate: adjuvant to clomiphene therapy of PCOS Enliven: Gynecologic Obestetric. 2014; 1(2): 004.
[6]
Ali H, Radhakrishnan G, Singh A. Comparison of metformin and N-acetylcysteine on metabolic parameters in women with polycystic ovarian syndrome. Int J Reprod Contracept Obstet Gynecol 2017; 6: 3076-84.
[http://dx.doi.org/10.18203/2320-1770.ijrcog20172938]
[7]
Maged AM, Elsawah H, Abdelhafez A, Bakry A, Mostafa WA. The adjuvant effect of metformin and N-acetylcysteine to clomiphene citrate in induction of ovulation in patients with Polycystic Ovary Syndrome. Gynecol Endocrinol 2015; 31(8): 635-8.
[http://dx.doi.org/10.3109/09513590.2015.1037269] [PMID: 26291797]
[8]
Bellver J, Rodríguez-Tabernero L, Robles A, et al. Group of interest in Reproductive Endocrinology (GIER) of the Spanish Fertility Society (SEF). Polycystic ovary syndrome throughout a woman’s life. J Assist Reprod Genet 2018; 35(1): 25-39.
[http://dx.doi.org/10.1007/s10815-017-1047-7] [PMID: 28951977]
[9]
Gupta V, Chaurasia A, Khatoon S, Singh UB. A study of N-acetyl cysteine, metformin and vitamin D3 with calcium on clinical and metabolic profile in PCOS. Int J Reprod Contracept Obstet Gynecol 2017; 6(10): 4372-6.
[http://dx.doi.org/10.18203/2320-1770.ijrcog20174407]
[10]
Behrouzi Lak T, Hajshafiha M, Nanbakhsh F, Oshnouei S. N-acetyl cysteine in ovulation induction of PCOS women underwent intrauterine insemination: An RCT. Int J Reprod Biomed (Yazd) 2017; 15(4): 203-8.
[http://dx.doi.org/10.29252/ijrm.15.4.203] [PMID: 28835936]
[11]
Amooee S, Parsanezhad ME, Ravanbod Shirazi M, Alborzi S, Samsami A. Metformin versus chromium picolinate in clomiphene citrate-resistant patients with PCOs: A double-blind randomized clinical trial. Iranian J Reproduct Med 2013; 11(8): 611-8.
[12]
Lydic ML, McNurlan M, Bembo S, Mitchell L, Komaroff E, Gelato M. Chromium picolinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome. Fertil Steril 2006; 86(1): 243-6.
[http://dx.doi.org/10.1016/j.fertnstert.2005.11.069]
[13]
Escobar-Morreale H F. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrin 2018; 14(5): 270-84.
[http://dx.doi.org/10.1038/nrendo.2018.24]
[14]
El Hayek S, Bitar L, Hamdar LH, Mirza FG, Daoud G. Poly cystic ovarian syndrome: An updated overview. Front Physiol 2016; 7: 124.
[http://dx.doi.org/10.3389/fphys.2016.00124] [PMID: 27092084]
[15]
Misso M, Boyle J, Norman R, Teede H. Development of evidenced-based guidelines for PCOS and implications for community health. Semin Reprod Med 2014; 32(3): 230-40.
[http://dx.doi.org/10.1055/s-0034-1371095] [PMID: 24715518]
[16]
Günalan E, Yaba A, Yılmaz B. The effect of nutrient supplementation in the management of polycystic ovary syndromeassociated metabolic dysfunctions: A critical review. J Turkish German Gynecol Assoc 2018; 19(4): 220-32.
[17]
Amr N, Abdel-Rahim HE. The effect of chromium supplementation on polycystic ovary syndrome in adolescents. J Pediatr Adolesc Gynecol 2015; 28(2): 114-8.
[http://dx.doi.org/10.1016/j.jpag.2014.05.005] [PMID: 25850593]
[18]
Hsu MI. Clinical characteristics in Taiwanese women with polycystic ovary syndrome. Clin Exp Reprod Med 2015; 42(3): 86-93.
[http://dx.doi.org/10.5653/cerm.2015.42.3.86] [PMID: 26473107]
[19]
Sanad AS. Prevalence of polycystic ovary syndrome among fertile and infertile women in Minia Governorate, Egypt. Int J Gynaecol Obstet 2014; 125(1): 81-2.
[http://dx.doi.org/10.1016/j.ijgo.2013.09.025] [PMID: 24434230]
[20]
Nsrallah AA, Abd-El Fatah AH, Ahmed HS. Genetic polymorphism of methylenetetrahydrofolate reductase is associated with insulin resistance in Egyptian women with polycystic ovary syndrome. J Gene Med 2019; 21(4): e3076.
[http://dx.doi.org/10.1002/jgm.3076]
[21]
Jamilian M, Bahmani F, Siavashani MA, Mazloomi M, Asemi Z, Esmaillzadeh A. The effects of chromium supplementation on endocrine profiles, biomarkers of inflammation, and oxidative stress in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Biol Trace Elem Res 2016; 172(1): 72-8.
[http://dx.doi.org/10.1007/s12011-015-0570-6] [PMID: 26613790]
[22]
Ashoush S, Abou-Gamrah A, Bayoumy H, Othman N. Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: Randomized controlled trial. J Obstet Gynaecol Res 2016; 42(3): 279-85.
[http://dx.doi.org/10.1111/jog.12907] [PMID: 26663540]
[23]
Salehpour S, Sene AA, Saharkhiz N, Sohrabi MR, Moghimian F. N-Acetylcysteine as an adjuvant to clomiphene citrate for successful induction of ovulation in infertile patients with polycystic ovary syndrome. J Obstet Gynaecol Res 2012; 38(9): 1182-6.
[http://dx.doi.org/10.1111/j.1447-0756.2012.01844.x] [PMID: 22540635]
[24]
Rizk AY, Bedaiwy MA, Al-Inany HG. N-acetyl-cysteine is a novel adjuvant to clomiphene citrate in clomiphene citrate-resistant patients with polycystic ovary syndrome. Fertil Steril 2005; 83(2): 367-70.
[http://dx.doi.org/10.1016/j.fertnstert.2004.07.960] [PMID: 15705376]
[25]
Nemati M, Nemati S, Taheri AM, Heidari B. Comparison of metformin and N-acetyl cysteine, as an adjuvant to clomiphene citrate, in clomiphene-resistant women with polycystic ovary syndrome. J Gynecol Obstet Hum Reprod 2017; 46(7): 579-85.
[http://dx.doi.org/10.1016/j.jogoh.2017.07.004] [PMID: 28698075]
[26]
Fulghesu AM, Ciampelli M, Muzj G, et al. N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Fertil Steril 2002; 77(6): 1128-35.
[http://dx.doi.org/10.1016/S0015-0282(02)03133-3] [PMID: 12057717]
[27]
Cheraghi E, Soleimani Mehranjani M, Shariatzadeh MA, Nasr Esfahani MH, Ebrahimi Z. Co-Administration of metformin and N-Acetyl cysteine fails to improve clinical manifestations in PCOS individual undergoing ICSI. Int J Fertil Steril 2014; 8(2): 119-28.
[PMID: 25083175]

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