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Abstract
Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrine disorders of uncertain etiology, which affect between 6%-10% of women at reproductive age. It is characterized by menstrual abnormalities, hirsutism, acne anovulatory infertility, and elevated androgens. It has been confirmed that insulin resistance is a common feature in either obese or non obese women with PCOS (Tsilchoro- Zidau et al., 2004).
Clomiphene citrate (CC) therapy has variable success rates in anovulatory women; however, it is the lowest in women with PCOS, particularly those with insulin resistance. Currently there is increasing evidence that insulin sensitizers are particularly effective in inducing ovulation in patients with PCOS (Rizk et al, 2005).
Metformin, a biguanide, is the most widely used drug for the treatment of type 2 diabetes worldwide. Its primary action is to inhibit hepatic glucose production, but it also increases the sensitivity of peripheral tissues to insulin. The increase in insulin sensitivity, which contributes to the efficacy of metformin in the treatment of diabetes, has also been shown in nondiabetic women with the polycystic ovary syndrome (Nestler 2008). In women with the syndrome, long-term treatment with metformin may increase ovulation, improve menstrual cyclicity, and reduce serum androgen levels(Cheang et al 2006).
N-acetyl cysteine (NAC) is commonly used as a safe mucolytic drug, and at higher doses it increases the cellular levels of reduced glutathione, an antioxidant, which has been shown to influence insulin receptor activity.(Rizk et al, 2005).
Fulghesu et al. (2002) demonstrated that N-acetyl cysteine treatment (1.8g/d for 5-6weeks) was associated with significant increase in insulin sensitivity and reduction in insulin levels, testosterone, and free androgen index in hyperinsulinemic PCOS.