AbstractObjective. To review the benefits and harms of N-acetylcysteine (NAC) in women with polycystic ovary syndrome (PCOS). Method. Literature search was conducted using the bibliographic databases, MEDLINE (Ovid), CINAHL, EMBASE, Scopus, PsyInfo, and PROQUEST (from inception to September 2013) for the studies on women with PCOS receiving NAC. Results. Eight studies with a total of 910 women with PCOS were randomized to NAC or other treatments/placebo. There were high risk of selection, performance, and attrition bias in two studies and high risk of reporting bias in four studies. Women with NAC had higher odds of having a live birth, getting pregnant, and ovulation as compared to placebo. However, women with NAC were less likely to have pregnancy or ovulation as compared to metformin. There was no significant difference in rates of the miscarriage, menstrual regulation, acne, hirsutism, and adverse events, or change in body mass index, testosterone, and insulin levels with NAC as compared to placebo. Conclusions. NAC showed significant improvement in pregnancy and ovulation rate as compared to placebo. The findings need further confirmation in well-designed randomized controlled trials to examine clinical outcomes such as live birth rate in longer follow-up periods.

IntroduksiPolycystic Ovary Syndrome (PCOS) most common endocrine disorders

5-15% reproductive age women have PCOS.

Associated with:• Anovulation• Infertility• Insulin resistance• Hyperandrogenism

First line treatment:Clomiphene citrate (CC) chronic anovulation15-40% failure to ovulate post 150 mg/day

CC vs. LOD vs. Gonadotropin vs. Metformin

• CC discrepancy : ovulation rate (75-80%), conception rate (30-40%)

• LOD (-)• Gonadotropin might too• Metformin insulin + androgen + sex-

hormone-binding globulin improve endocrine parameter

• Metformin clinical pregnancy + ovulation rate live birth rate

NACCommonly used safe mucolytic drug

Cellular antioxidant levels + glutathione

Potential to:• improve insulin receptor activity in RBC • improve insulin secretion

circulating insulin levels testosterone levels + free androgen index

Advantages:1. Prevent endothelial damage e.c. oxidants in noninsulin-dependent

adult diabetic subjects2. Protection against focal ischemia, proinflammatory cytokine release,

protease activity

• Suggestion: effects exerted by NAC (ovarian level) may be beneficial : insulin-enhancing effects induce ovulation

Effective treatment options for PCOS (-)• Needs: establishment of data on new options NAC as monoTx / supportive Tx

Objective

To determine if NAC therapy more effective and safe in women with PCOS vs. placebo/metformin.