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Review
. 2015;2015:817849.
doi: 10.1155/2015/817849. Epub 2015 Jan 8.

N-acetylcysteine for Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials

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Free PMC article
Review

N-acetylcysteine for Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials

Divyesh Thakker et al. Obstet Gynecol Int. .
Free PMC article

Abstract

Objective. To review the benefits and harms of N-acetylcysteine (NAC) in women with polycystic ovary syndrome (PCOS). Method. Literature search was conducted using the bibliographic databases, MEDLINE (Ovid), CINAHL, EMBASE, Scopus, PsyInfo, and PROQUEST (from inception to September 2013) for the studies on women with PCOS receiving NAC. Results. Eight studies with a total of 910 women with PCOS were randomized to NAC or other treatments/placebo. There were high risk of selection, performance, and attrition bias in two studies and high risk of reporting bias in four studies. Women with NAC had higher odds of having a live birth, getting pregnant, and ovulation as compared to placebo. However, women with NAC were less likely to have pregnancy or ovulation as compared to metformin. There was no significant difference in rates of the miscarriage, menstrual regulation, acne, hirsutism, and adverse events, or change in body mass index, testosterone, and insulin levels with NAC as compared to placebo. Conclusions. NAC showed significant improvement in pregnancy and ovulation rate as compared to placebo. The findings need further confirmation in well-designed randomized controlled trials to examine clinical outcomes such as live birth rate in longer follow-up periods. Systematic review registration number is CRD42012001902.

Figures

Figure 1
Figure 1
PRISMA flow diagram for selection of studies for the systematic review. Flow diagram style adapted from Moher et al. [12].
Figure 2
Figure 2
Cochrane risk of bias rool summary for included studies.
Figure 3
Figure 3
Forest plot: outcome: live birth rate in women with PCOS comparing NAC with placebo.
Figure 4
Figure 4
Forest plot: outcome: pregnancy rate in women with PCOS comparing NAC with placebo.
Figure 5
Figure 5
Forest plot: outcome: pregnancy rate in women with PCOS comparing NAC with metformin.
Figure 6
Figure 6
Forest plot: outcome: ovulation rate in women with PCOS comparing NAC with placebo.
Figure 7
Figure 7
Forest plot: outcome: body-mass index (BMI) (kg/m2) in women with PCOS comparing NAC with placebo/metformin.
Figure 8
Figure 8
Forest plot: outcome: testosterone level (nmol/L) in women with PCOS comparing NAC with placebo/metformin.
Figure 9
Figure 9
Forest plot: outcome: fasting glucose (mg/dL) in women with PCOS comparing NAC with placebo/metformin.

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