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 Nacetyl 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.