Randomized controlled trial of N-acetylcysteine versus l-carnitine among women with clomiphene-citrate-resistant polycystic ovary syndrome

Int J Gynaecol Obstet. 2019 Oct;147(1):59-64. doi: 10.1002/ijgo.12902. Epub 2019 Jul 17.

Abstract

Objective: To compare clinical and metabolic profiles between N-acetylcysteine and l-carnitine among women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS).

Methods: A randomized trial at Zagazig University between January 2017 and March 2018. Women with CC-resistant PCOS were allocated randomly to receive CC plus N-acetylcysteine or CC plus l-carnitine. The primary outcome was clinical pregnancy rate; secondary outcomes were ovulation rate and metabolic changes.

Results: Overall, 162 women completed the study (N-acetylcysteine group, n=82; l-carnitine group, n=80). After 3 months, there was no difference in pregnancy (P=0.15), ovulation (P=0.21), or spontaneous abortion (P=0.11) rates between the two groups. There was no significant decrease in BMI in either group (both P>0.05). There were improvements in menstrual pattern, follicle-stimulating hormone, luteinizing hormone, free testosterone, and insulin resistance markers in both groups (all P<0.05). An improvement in lipid profile was observed only in the l-carnitine group (P<0.001). N-Acetylcysteine treatment led to significantly greater improvement in free testosterone and insulin resistance parameters as compared with l-carnitine (all P<0.05).

Conclusions: Both N-acetylcysteine and l-carnitine were equally effective in improving pregnancy and ovulation rates among women with CC-resistant PCOS. However, N-acetylcysteine was superior in ameliorating insulin resistance and only l-carnitine improved lipid profile.

Trial registration: ClinicalTrials.gov: NCT03164421.

Keywords: Clomiphene citrate; N-acetylcysteine; Polycystic ovary syndrome; Resistance; l-Carnitine.

Publication types

  • Randomized Controlled Trial
  • Retracted Publication

MeSH terms

  • Acetylcysteine / therapeutic use*
  • Adult
  • Carnitine / therapeutic use*
  • Clomiphene / therapeutic use
  • Double-Blind Method
  • Female
  • Follicle Stimulating Hormone / metabolism
  • Humans
  • Infertility, Female / drug therapy
  • Infertility, Female / etiology
  • Insulin Resistance
  • Ovulation / drug effects
  • Ovulation Induction / methods
  • Polycystic Ovary Syndrome / complications
  • Polycystic Ovary Syndrome / drug therapy*
  • Pregnancy
  • Pregnancy Rate
  • Young Adult

Substances

  • Clomiphene
  • Follicle Stimulating Hormone
  • Carnitine
  • Acetylcysteine

Associated data

  • ClinicalTrials.gov/NCT03164421