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

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 N-acetyl 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.