Effect of N-acetyl-cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study

Reprod Biomed Online. 2010 Mar;20(3):403-9. doi: 10.1016/j.rbmo.2009.12.012. Epub 2009 Dec 14.


The aim of this randomized double-blind placebo-controlled pilot study was to evaluate N-acetyl-cysteine (NAC) as an adjunctive therapy following unilateral laparoscopic ovarian drilling (LOD) for clomiphene citrate-resistant women with polycystic ovary syndrome (PCOS). A total of 60 patients with clomiphene citrate-resistant PCOS who underwent unilateral LOD were assigned randomly to receive either NAC 1.2 g/d (group A=30) or placebo (group B=30) for 5 days starting at day 3 of the cycle for 12 consecutive cycles. The primary outcome was pregnancy rate; secondary outcomes were ovulation rates, endometrial thickness and pregnancy outcome. Baseline clinical, endocrine, and sonographic characteristics were similar in the two groups. A significant increase in both ovulation and pregnancy rates was observed in the NAC group, compared with placebo [87% versus 67% (RR 1.3; 95% CI 1.2-2.7) and 77% versus 57% (RR 1.4; 95% CI 1.1-2.7), respectively, P<0.01]. Moreover, miscarriage rates were significantly lower and live birth rates were significantly higher in the NAC group [8.7% versus 23.5% (RR 0.4; 95% CI 0.1-3.7) and 67% versus 40% (RR 1.7; 95% CI 0.3-3.5), respectively, P<0.01]. In conclusion, NAC is a novel adjuvant therapy after unilateral LOD which might help improve overall reproductive outcome.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetylcysteine / therapeutic use*
  • Adolescent
  • Adult
  • Clomiphene / therapeutic use
  • Drug Resistance
  • Female
  • Fertility Agents, Female / therapeutic use*
  • Humans
  • Laparoscopy
  • Ovary / surgery*
  • Ovulation / drug effects
  • Ovulation Induction / methods
  • Pilot Projects
  • Placebos
  • Polycystic Ovary Syndrome / drug therapy*
  • Pregnancy
  • Pregnancy Rate


  • Fertility Agents, Female
  • Placebos
  • Clomiphene
  • Acetylcysteine