{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:25:18Z","timestamp":1787775918603,"version":"build-2784847793"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,1]]},"abstract":"\n Background:<\/jats:title>\n This study was aimed to evaluate the influence of oral N-acetylcysteine (NAC) application as an adjuvant to letrozole on induced ovulation outcomes in patients with polycystic ovary syndrome (PCOS).<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n \n This was a placebo-controlled double-blind randomized clinical trial with 130 PCOS patients who were infertile. First, patients were randomly divided into two groups. Patients in Group 1 were administered letrozole 5 mg\/d plus NAC 1.2 g\/d and patients in Group 2 were administered letrozole plus placebo for 5 days starting at the 3\n rd<\/jats:sup>\n day of the menstruation period. On the 12\n th<\/jats:sup>\n day of the cycle, ultrasound evaluation was performed, and in whom at least one follicle with an 18\u201320 mm diameter was found, 10,000 unit human chorionic gonadotropin (hCG) was prescribed, and 36 h after hCG injection, timed intercourse was advised. On the 16\n th<\/jats:sup>\n day, after hCG injection, serum \u03b2-hCG level was evaluated.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n The number of follicles >18 mm was significantly higher in the letrozole + NAC group (\n P<\/jats:italic>\n = 0.007). The ovulation and pregnancy rates were also significantly higher in the letrozole + NAC group (\n P<\/jats:italic>\n = 0.045). No adverse side effects and no cases of ovarian hyperstimulation syndrome were observed in NAC group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n NAC is demonstrated to be a safe and well-tolerated adjuvant to letrozole and can increase the pregnancy rates in PCOS patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/abr.abr_157_17","type":"journal-article","created":{"date-parts":[[2018,6,25]],"date-time":"2018-06-25T06:15:25Z","timestamp":1529907325000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":13,"title":["N-Acetylcysteine as an Adjuvant to Letrozole for Induction of Ovulation in Infertile Patients with Polycystic Ovary Syndrome"],"prefix":"10.4103","volume":"7","author":[{"given":"Fateme","family":"Mostajeran","sequence":"first","affiliation":[{"name":"From the Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatav Ghasemi","family":"Tehrani","sequence":"additional","affiliation":[{"name":"From the Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahare","family":"Rahbary","sequence":"additional","affiliation":[{"name":"From the Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,6,25]]},"reference":[{"key":"R1-20251008","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1038\/nrendo.2010.217","article-title":"Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis","volume":"7","author":"Goodarzi","year":"2011","journal-title":"Nat Rev Endocrinol"},{"key":"R2-20251008","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/j.1479-828X.2001.tb01296.x","article-title":"The current status of polycystic ovary syndrome","volume":"41","author":"Kovacs","year":"2001","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"R3-20251008","doi-asserted-by":"crossref","first-page":"S89","DOI":"10.1016\/S0002-9378(98)70238-8","article-title":"Polycystic ovary syndrome: Symptomatology, pathophysiology, and epidemiology","volume":"179","author":"Guzick","year":"1998","journal-title":"Am J Obstet Gynecol"},{"key":"R4-20251008","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/humrep\/deh098","article-title":"Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)","volume":"19","year":"2004","journal-title":"Hum Reprod"},{"key":"R5-20251008","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0277-9536(01)00034-X","article-title":"'The thief of womanhood': Women's experience of polycystic ovarian syndrome","volume":"54","author":"Kitzinger","year":"2002","journal-title":"Soc Sci Med"},{"key":"R6-20251008","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1210\/rp.56.1.295","article-title":"Insulin resistance in polycystic ovary syndrome: Progress and paradoxes","volume":"56","author":"Venkatesan","year":"2001","journal-title":"Recent Prog Horm Res"},{"key":"R7-20251008","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1093\/oxfordjournals.humrep.a137058","article-title":"Insulin secretion in polycystic ovarian disease: Effect of ovarian suppression by GnRH agonist","volume":"5","author":"Lanzone","year":"1990","journal-title":"Hum Reprod"},{"key":"R8-20251008","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1056\/NEJM199608293350909","article-title":"Insulin and the polycystic ovary syndrome","volume":"335","author":"Utiger","year":"1996","journal-title":"N Engl J Med"},{"key":"R9-20251008","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.fertnstert.2007.05.010","article-title":"Anastrozole or letrozole for ovulation induction in clomiphene-resistant women with polycystic ovarian syndrome: A prospective randomized trial","volume":"89","author":"Badawy","year":"2008","journal-title":"Fertil Steril"},{"key":"R10-20251008","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/S0015-0282(01)02929-6","article-title":"A nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility","volume":"77","author":"Imani","year":"2002","journal-title":"Fertil Steril"},{"key":"R11-20251008","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1093\/humupd\/dmn033","article-title":"Use of letrozole in assisted reproduction: A systematic review and meta-analysis","volume":"14","author":"Requena","year":"2008","journal-title":"Hum Reprod Update"},{"key":"R12-20251008","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1016\/S0015-0282(02)03133-3","article-title":"N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome","volume":"77","author":"Fulghesu","year":"2002","journal-title":"Fertil Steril"},{"key":"R13-20251008","first-page":"296","article-title":"N-acetyl cysteine treatment for polycystic ovary syndrome","volume":"85","author":"Kilicokman","year":"2004","journal-title":"IntjGynaecolobstet"},{"key":"R14-20251008","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/00005344-199807000-00016","article-title":"Oral administration of the antioxidant, N-acetylcysteine, abrogates diabetes-induced endothelial dysfunction","volume":"32","author":"Pieper","year":"1998","journal-title":"J Cardiovasc Pharmacol"},{"key":"R15-20251008","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.fertnstert.2005.05.078","article-title":"A new era in ovulation induction","volume":"85","author":"Holzer","year":"2006","journal-title":"Fertil Steril"},{"key":"R16-20251008","first-page":"210","article-title":"The effectiveness of using of N acetyl cysteine together with clomiphene citrate on ovulation indication in the patients with polycystic ovary syndrome referred to Isfahan reproduction and infertility center, 2013","volume":"2","author":"Riyahinezhad","year":"2015","journal-title":"J Sci Res Dev"},{"key":"R17-20251008","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.fertnstert.2004.07.960","article-title":"N-acetyl-cysteine is a novel adjuvant to clomiphene citrate in clomiphene citrate-resistant patients with polycystic ovary syndrome","volume":"83","author":"Rizk","year":"2005","journal-title":"Fertil Steril"},{"key":"R18-20251008","first-page":"66","article-title":"Nacetyl cysteine, a novel remedy for polycystic ovarian syndrome","volume":"3","author":"Salehpour","year":"2009","journal-title":"Int J Fuzzy Syst"},{"key":"R19-20251008","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1007\/BF03345763","article-title":"Prolonged treatment with N-acetylcysteine and L-arginine restores gonadal function in patients with polycystic ovary syndrome","volume":"32","author":"Masha","year":"2009","journal-title":"J Endocrinol Invest"},{"key":"R20-20251008","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1007\/s001250051082","article-title":"Reduction of oxidative stress by oral N-acetyl-L-cysteine treatment decreases plasma soluble vascular cell adhesion molecule-1 concentrations in non-obese, non-dyslipidaemic, normotensive, patients with non-insulin-dependent diabetes","volume":"41","author":"De Mattia","year":"1998","journal-title":"Diabetologia"},{"key":"R21-20251008","doi-asserted-by":"crossref","first-page":"499","DOI":"10.2337\/diabetes.52.2.499","article-title":"Comparative trial of N-acetyl-cysteine, taurine, and oxerutin on skin and kidney damage in long-term experimental diabetes","volume":"52","author":"Odetti","year":"2003","journal-title":"Diabetes"}],"container-title":["Advanced Biomedical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01679891-201807000-00100","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:46:05Z","timestamp":1787773565000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01679891-201807000-00100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.4103\/abr.abr_157_17","relation":{},"ISSN":["2277-9175"],"issn-type":[{"value":"2277-9175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1]]},"assertion":[{"value":"2017-09-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-04-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}