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N-Acetyl Cysteine May Help PCOS If Clomid Fails
Many women with PCOS are diagnosed as being 'Clomid-resistant' when their ovaries refuse to respond to stimulation by clomiphene citrate. Such women are often hastened to try stronger and stronger ovarian-stimulating medications - or IVF - but a simple, inexpensive and lesser-known treatment may help.
N-acetylcysteine (NAC) is an antioxidant which is being increasingly studied in PCOS women and shows promise as a novel way to improve the ovulation response to Clomid. N-acetylcysteine appears to; improve insulin sensitivity, decrease androgen levels and can help a PCOS woman to ovulate without resorting to IVF. Here is a summary of the latest studies.
In the first study - N-acetyl-cysteine is a novel adjuvant to clomiphene citrate in clomiphene citrate-resistant patients with polycystic ovary syndrome - 150 women with PCOS who were resistant to clomiphene citrate were given 1.2 g of NAC a day or a placebo alongside 100 mg of Clomid for five days beginning on day 3 of the cycle. This was a placebo-controlled, double-blind randomized trial.
The combination of NAC with clomiphene citrate increased both the ovulation rate (49% versus 1.3%) and pregnancy rate (21% versus 0%). Only two miscarriages (12.5%) occurred and the researchers concluded that;
"The NAC as an adjuvant to CC was more effective than placebo for CC-resistant patients with PCOS. It is safe and well tolerated."
In a second similar study on the combination - N-Acetyl cysteine and clomiphene citrate for induction of ovulation in polycystic ovary syndrome - a cross-over trial - five hundred and seventy-three patients with PCOS were treated with Clomid for one cycle. Subsequently 470 women were given Clomid and NAC for one cycle.
Clomid was given for five days beginning on day 3 in a dose of 50 mg twice a day and the NAC dose was 1,200 mg/day taken concurrently. Once again ovulation rates improved significantly when NAC was added to Clomid (52% with NAC) as did the pregnancy rate (11.5%), improvements were also seen in endometrial thickness, estradiol and progesterone levels. The researchers of the study concluded that;
"N-Acetyl cysteine is proved effective in inducing or augmenting ovulation in polycystic ovary patients."
In a third study the effect of NAC on insulin secretion and peripheral insulin resistance in PCOS women was the focus. This small study observed 37 PCOS women; six lean and 32 obese aged between 19 and 33 years. A total amount of 1.8 g/day of NAC was given for 5-6 weeks and patients who were 'massively obese' took 3 g/day. Six of the obese PCOS women were control subjects.
Although fasting glucose and fasting insulin levels did not change, the peripheral insulin sensitivity increased and there was a significant fall in testosterone levels and in the free androgen index values. The researchers concluded that;
"NAC may be a new treatment for the improvement of insulin circulating levels and insulin sensitivity in hyperinsulinemic patients with polycystic ovary syndrome."
In a forth and final study - 'Prolonged treatment with N-acetylcysteine and L-arginine restores gonadal function in patients with polycystic ovary syndrome' - eight women with PCOS were treated with a combination of 1200 mg/day of NAC and 1600 mg/day of L-Arginine for six months. All the women had experienced either lack of menses or erratic menses for at least one year.
During the study menstruation was restored and bi-phasic temperature charts indicated ovulation, the researchers concluded that;
"this preliminary, open study suggests that prolonged treatment with NAC+ARG might restore gonadal function in PCOS. This effect seems associated to an improvement in insulin sensitivity."
If you are not responding well to Clomid, ask your physician about trying NAC and L-Arginine on your next cycle. These are just a few of the multiple ways that you may be able to help your ovaries to function better when PCOS is your diagnosis.
This article is for informational and educational purposes only and is not a substitute for diagnosis or medical or nutritional advice for which you should consult a physician or dietitian.
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Fertil Steril. Feb;83(2):367-70.
N-acetyl-cysteine is a novel adjuvant to clomiphene citrate in clomiphene citrate-resistant patients with polycystic ovary syndrome. Rizk AY et al.
Acta Obstet Gynecol Scand. 2007;86(2):218-22.
N-Acetyl cysteine and clomiphene citrate for induction of ovulation in polycystic ovary syndrome: a cross-over trial. Badawy A, State O, Abdelgawad S.
Fertil Steril. 2002 Jun;77(6):1128-35.
N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Fulghesu AM et al.
J Endocrinol Invest. 2009 Dec;32(11):870-2. Epub 2009 Apr 15.
Prolonged treatment with N-acetylcysteine and L-arginine restores gonadal function in patients with polycystic ovary syndrome. Masha A, et al.
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