Objective: The aim of this study was to evaluate the effect of N-Acetyl-Cysteine (NAC) as an adjuvant therapy to
ovulation induction using the low fixed dose human menopausal gonadotropins (HMG) in cases prepared for ICSI.
Design : prospective randomized controlled study.
Materials and methods: The study was conducted on 40 patients. The selected cases were less than 40 years old and
were diagnosed as having tubal or male factor infertility planned for ICSI. The patients were randomly divided into two
equal groups: a control group and a study group, Both groups received 150 TU HMG per day from cycle clay two till the
day of human chorionic gonadotropins (HCG). In addition, the study group received NAC, 1200 nig daily in throe
divided doses form cycle day two till the day of HCG. Patients were monitored using serial (ransvaginal sonography.
Before administration of HCG the serum level of oeslradiol and progesterone were measured. Testosterone was
measured in the follicular fluid.
Results : The NAC group showed a significant decrease in the HMG requirements (18.3 Vs. 20 ampoules). NAC led to
a significanl increase in the final serum oeslradiol level (1375 pg/ml Vs. 793 pg/ml). The number of the retrieved
oocytes was higher (non-significant) in the study group; it resulted in a significanl increase in the number of mature
oocytes and higher rate of fertilization. NAC led to an insignificant drop in follicular fluid testosterone. However, these
positive effects of NAC did not lead lo a significant change in the pregnancy rate.
Conclusion: The use of NAC as an adjuvant to the low fixed dose gonadolropin protocol in cases prepared for ICSI
improved cycle parameters but it did not result in a significant effect on follicular fluid testosterone concentration or the
pregnancy rates.