Oxidative Stress in Polycystic Ovarian Syndrome and the Effect of Antioxidant N-Acetylcysteine on Ovulation and Pregnancy Rate

Jasmine K Sandhu; Ahsan Waqar; Ashish Jain; Christine Joseph; Kosha Srivastava; Olive Ochuba; Tasnim Alkayyali; Sheila W Ruo; Sujan Poudel

doi:10.7759/cureus.17887

Oxidative Stress in Polycystic Ovarian Syndrome and the Effect of Antioxidant N-Acetylcysteine on Ovulation and Pregnancy Rate

Cureus. 2021 Sep 11;13(9):e17887. doi: 10.7759/cureus.17887. eCollection 2021 Sep.

Authors

Jasmine K Sandhu¹, Ahsan Waqar², Ashish Jain³, Christine Joseph⁴, Kosha Srivastava⁵, Olive Ochuba³, Tasnim Alkayyali^{6

7}, Sheila W Ruo⁸, Sujan Poudel⁹

Affiliations

¹ Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
² Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
³ Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁴ Urology/Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁵ Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁶ Internal Medicine, Marmara University, Istanbul, TUR.
⁷ Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁸ General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁹ Psychiatry and Behavioral Sciences, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

Abstract

Polycystic ovarian syndrome (PCOS) is an endocrinological condition that leads to infertility in many females. N-acetylcysteine (NAC), a novel antioxidant, is being used as an adjuvant to treat infertility in females suffering from PCOS. This review aims to evaluate oxidative stress in females suffering from PCOS and assess whether the anti-oxidizing properties of NAC are beneficial in enhancing the rate of ovulation and pregnancy in infertile PCOS females. A literature search was conducted manually on PubMed and Google Scholar databases using the following keywords: "N-Acetylcysteine," "PCOS," "Oxidative stress," "Antioxidants," and "infertility" alone and/or in combination for data collection. The studies were manually screened and, after applying inclusion-exclusion criteria, 32 studies consisting of 2466 females of the reproductive age group are included in this review. Our review revealed that females suffering from PCOS tend to show elevated levels of inflammatory markers and a decrease in antioxidant capacity. When used in combination with clomiphene citrate or letrozole, NAC increases ovulation and pregnancy rate in infertile females suffering from PCOS and positively affects the quality of oocytes and number of follicles ≥18mm. Moreover, its side effect profile is low. It also results in a mild increase in endometrial thickness in some females. Future studies on a large sample size using NAC alone are highly recommended to evaluate its role as a single-drug therapy for treating infertility in females suffering from PCOS.

Keywords: antioxidants; infertility; n-acetylcysteine; oxidative stress; pcos.

Publication types

Review