الفهرس 
Adjuvant to clomiphene citrate and metformin therapy in patients with PCOS
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Abstract
Background: Polycystic ovarian syndrome (PCOS) is a complex female medical condition defined as having hyperandrogenism, polycystic ovaries on ultrasound, and/or oligo- or anovulation, affecting about 6-10% of reproductive aged women. Clomiphene citrate (CC), the traditional first-line medication for induction of ovulation in anovulatory women. Combining metformin and CC give higher rates of regular cycles, ovulation success and conception when compared with treatment with CC alone. In the past few years there has been increasing interest in the use of insulin-sensitizing drugs in women with PCOS. These drugs include metformin, chromium picolinate, N-acetyl cysteine and others. Objectives: In our study we 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. Methods: This study has been carried out on 108 patients diagnosed with PCOS and fulfilling Rotterdam criteria 2003. Patients were divided into three equal groups. The first group were given clomiphene citrate plus metformin only. The second group were given clomiphene citrate and metformin plus N-acetyl cysteine. The third group was given clomiphene citrate and metformin plus chromium picolinate. These cases were followed up for three cycles by transvaginal ultrasound folliculometry (number of follicles >18) and serum E2. Results: The results of the present study revealed that the adjuvant chromium picolinate and N-acetyl cysteine significantly increase the ovulation outcomes. On the other hand, chromium picolinate appears to be more effective than N-acetyl cysteine