N-Acetylcysteine for Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials
Open accessAbstract
Objective . 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. Systematic review registration number is CRD42012001902 .
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There was a 60% higher conception rate with metformin than with NAC.
“However, there was a 60% higher conception rate with metformin than with NAC.”
From Nutritional and herbal interventions for polycystic ovary syndrome (PCOS): a comprehensive review of dietary approaches, macronutrient impact, and herbal medicine in management (2025) · cites this paper as [192]
The Results (section 4) support the direction of the comparison: pregnancy was less likely with NAC than with metformin. But the reported 60% refers to lower odds with NAC relative to metformin (odds ratio 0.40), not a 60% higher conception rate with metformin relative to NAC. (LLM, conf=0.91)
Experimental — accuracy not yet measuredNAC was the only treatment that significantly decreased fasting blood glucose compared to metformin and placebo.
“Moreover, NAC proved to be the most effective option compared to metformin and placebo as it was the only one that significantly decreased fasting blood glucose.”
NAC did not make any difference in fasting insulin or HOMA-IR levels.
“At the same time, it did not make any difference in the fasting insulin or HOMA-IR levels [192].”
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- Authors
- Thakker, D., Raval, A., Patel, I., & Walia, R.
- Affiliations
- Department of Pharmacology, SAL Institute of Pharmacy, Ahmadabad, Gujarat 380060, India
- West Virginia University (US)
- Shenandoah University (US)
- Post Graduate Institute of Medical Education and Research (IN)
- Corresponding author
- Raval, Amit
- Venue
- Obstetrics and Gynecology International
- Publisher
- Wiley
- Published
- 2015
- Volume
- 2015
- Pages
- 1-13
- ISSN
- 1687-9589 (ISSN-L)
- 1687-9597
- PMC
- PMC4306416
- OpenAlex
- W1993780026
- Cited by
- 54
- References
- 31
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 3 · 2021: 9 · 2020: 7 · 2019: 5 · 2018: 5 · 2017: 1 · 2015: 1 · 2013: 1
- FWCI
- 0.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Obstetrics and Gynecology International (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Greater South Information System
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Keywords
- N-acetylcysteine, polycystic ovary syndrome, ovulation induction, pregnancy rate, live birth, metformin, hirsutism, acne, menstrual regulation, insulin, testosterone, body mass index, adverse events
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