الفهرس 
Chapter 1: polycystic ovaryOnly 14 pages are availabe for public view
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Abstract
Summary
PCOS is the most common endocrine abnormality in reproductive age women. The prevalence of PCOS is traditionally estimated at 4% to 8% from studies performed in Greece, Spain and the USA.
The prevalence of PCOS has increased with the use of different diagnostic methods.The diagnostic criteria for PCOS include two of the following three factors: chronic oligomenorrhea or anovulation, hyperandrogenism, and polycystic ovarian morphology
Clomiphene citrate (CC) remains the first choice for induction of ovulation in anovulatory women with PCOS. Cost of medication is low and the oral route of administration is patient friendly, There are relatively few adverse effects, It decreases the need for many ovarian response monitoring and abundant clinical data are available regarding safety of the drug.
Clomiphene resistance defined as failure to ovulate after receiving 150 mg of CC daily for 5 days per cycle, for at least three cycles and occurs in approximately 15-40% in women with PCOS. Insulin resistance, hyperandrogenemia, and obesity represent the major factors involved in CC resistance; avert the ovaries from responding to raised endogenous FSH levels following CC therapy.
N-acetyl cysteine (NAC) is the acetylated variant of the amino acid L-cysteine. It is an excellent source of sulfhydryl groups and is converted in vivo into metabolites that stimulate glutathione production, promote detoxification, and act directly as free-radical scavengers. Historically, Summary
Summary
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NAC is a mucolytic in a variety of respiratory illnesses. It is primarily a powerful antioxidant; it has activity on insulin secretion in pancreatic cells and on insulin receptors on human erythrocytes. NAC has antiapoptotic effects; it can preserve vascular integrity and has immunological functions.
This controlled randomized clinical trial was conducted at Beni suef university hospital and private infertility practice between November 2013 and November 2015 to evaluate the effect of oral NAC administration as an adjuvant to CC on induction of ovulation outcomes in PCOS patients. The study included one hundred and fifty (150) PCOS infertile patients selected on basis of women who fulfilled the diagnostic criteria for PCOS include two of the following three factors: chronic oligomenorrhea or anovulation, hyperandrogenism, and polycystic ovarian morphology.
The selected women were randomly arranged by closed envelop method into two groups, (clomiphene with NAC (CC+NAC)group 1 and clomiphene with placebo (CC+Placebo)group 2 , seventy five (75) women in each group.
Patients in group 1 received CC 100 mg/d plus NAC 1.2 g/d and patients in group 2 received CC plus placebo for 5 days starting at day 3 of the cycle.
There was no statistically significant difference between both groups as regarding to age, weight, height , BMI , infertility duration , FSH , LH , FSH/LH ratio (tables1,2,3). By vaginal U/S at day 12 th of cycle we found that there were mature follicles more than 18mm in about 48 women of the included 150 women. The incidence of ovulation in the NAC group was 40% (30/75) and in the controlled group it was 24 % (18/75) and the difference is statistically significant (table 4).there was significant difference in pregnancy rate as about 18 women get pregnant
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in NAC group about 18.7 % while only 6 women get pregnant in controlled group about 8 %
Also the serum estradiol level and S.progesterone were significantly higher among patients who received CC+NAC compared to those patients who received CC+Placebo while there was no statistically difference about endometrial thickness and No of mature follicle .
In conclusion, based on our data, NAC as an adjuvant to CC for induction of ovulation can improve the ovulation and pregnancy rates in PCOS patients. NAC is well-tolerated, safe, and inexpensive and may be a novel adjuvant treatment to improve the induction of ovulation outcomes in PCOS patients
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