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Pourhoseini SA, Mahmoudinia M, Najaf Najafi M, Kamyabi F. The effect of phytoestrogens ( Cimicifuga racemosa) in combination with clomiphene in ovulation induction in women with polycystic ovarian syndrome: A clinical trial study. AVICENNA JOURNAL OF PHYTOMEDICINE 2022; 12:8-15. [PMID: 35145891 PMCID: PMC8801214 DOI: 10.22038/ajp.2021.47998.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/14/2020] [Accepted: 02/23/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Phytoestrogens can be used as an alternative to clomiphene for ovulation induction in patients with polycystic ovarian (PCO). In this study, we evaluated the impact of phytoestrogens (Cimicifuga racimosa) in combination with clomiphene on the endometrium thickness and follicle number in women with PCO. MATERIALS AND METHODS This study was a prospective clinical trial conducted in the infertility research center of Milad Hospital in Mashhad, Iran, during 2016 and 2017 on 100 women with PCO syndrome. The patients were randomly divided into two equal groups. The patients in both groups were treated by clomiphene citrate 50 mg, twice a day for 5 days, from the second day of the menstrual cycle and for three consecutive cycle periods. The intervention group received Cimicifuga racemosa tablets 10 mg twice a day for 10 days from the second day of the menstrual cycle, in addition to the mentioned standard treatment. The two groups were compared in terms of the number and size of follicles and endometrial thickness on the ultrasound. RESULTS There was no significant differences between the number of medium (p=0.288), large (p=0.086), and total (p=0.288) follicles between the two groups. Also, no significant difference was observed in endometrial thickness between the two groups (p=0.227). CONCLUSION As a result, adding Cimicifuga racemosa to clomiphene could not increase the endometrial thickness and the number of follicles in PCO patients.
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Affiliation(s)
- Seyedeh Azam Pourhoseini
- Department of Obstetrics, Faculty of Medicines, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh Mahmoudinia
- Department of Obstetrics, Faculty of Medicines, Mashhad University of Medical Sciences, Mashhad, Iran,Corresponding Author: Tel: + 989153047813. Fax: + 9851 3853 4021 ,
| | - Mona Najaf Najafi
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fouad Kamyabi
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Synergistic protective effects of lycopene and N-acetylcysteine against cisplatin-induced hepatorenal toxicity in rats. Sci Rep 2021; 11:13979. [PMID: 34234176 PMCID: PMC8263713 DOI: 10.1038/s41598-021-93196-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023] Open
Abstract
Cisplatin (CP) is one of the most frequently used chemotherapy agents. The objective of this design was to determine the ameliorative effect of lycopene (LP) and/or N-acetylcysteine (NAC) in rats with hepatic and renal toxicity induced by CP. Rats were divided randomly into 7 groups (7 rats/group): control vehicle group (saline only), the LP group (10 mg/kg, orally), the NAC group (150 mg/kg, orally), the CP group (7.5 mg/kg, IP on day 27), the LP-CP group, the NAC-CP group, and the LP-NAC-CP group. The activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (APK), and levels of urea, creatinine, and lipids (cholesterol, triglycerides, and low-density lipoprotein-cholesterol) increased after CP injection in the serum. Moreover, CP decreased levels of protein, albumin, and HDL cholesterol. Meanwhile, malondialdehyde significantly increased with a decrease in reduced glutathione, superoxide dismutase, and catalase in the liver and kidney tissues. CP also induced some pathological lesions and increased the expression of caspase-3 in the liver and kidney tissues. Administration of LP and NAC alone or in combinations ameliorated hepatorenal toxicity and apoptosis induced by CP.
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Feng J, Zhang XF, Ren JN, Huang YH, Zheng X. Efficacy of clomifene citrate combined Bushen Culuan Decoction for the treatment of infertility caused by polycystic ovary syndrome: A protocol of systematic review. Medicine (Baltimore) 2020; 99:e20969. [PMID: 32629707 PMCID: PMC7337480 DOI: 10.1097/md.0000000000020969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this study is to assess the efficacy and safety of clomifene citrate combined Bushen Culuan Decoction (CCBCD) in treating infertility caused by polycystic ovary syndrome (PCOS). METHODS We will carry out this study to identify eligible randomized controlled trials (RCTs) in Cochrane Library, PUBMED, EMBASE, Web of Science, CINAHL, and China National Knowledge Infrastructure from inception to the present. There are no limitations to the language and publication time. We will perform study selection, data extraction, and study quality assessment. If possible, a meta-analysis will be developed to judge the comparative efficacy and safety of CCBCD with other treatments. RESULTS The results of this study will summarize current high quality RCTs to provide direct evidence of CCBCD in treating infertility in patients with PCOS. CONCLUSION This study may provide evidence to determine whether CCBCD is effective and safe or not for the treatment of infertility caused by PCOS. STUDY REGISTRATION INPLASY202050090.
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Affiliation(s)
- Jing Feng
- Department of Gynecology, 521 Hospital of Norinco Group, Xi’an, Shaanxi, China
| | - Xiao-feng Zhang
- Department of Gynecology, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Jie-ning Ren
- Department of Obstetrics, Weinan Central Hospital, Weinan, Shaanxi, China
| | - Yu-hua Huang
- Department of Gynecology, 521 Hospital of Norinco Group, Xi’an, Shaanxi, China
| | - Xin Zheng
- Department of Gynecology, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, China
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Galal AAA, Ramadan RA, Metwally MMM, El-Sheikh SMA. Protective effect of N-acetylcysteine on fenitrothion-induced toxicity: The antioxidant status and metabolizing enzymes expression in rats. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 171:502-510. [PMID: 30639957 DOI: 10.1016/j.ecoenv.2019.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 06/09/2023]
Abstract
The existence of fenitrothion (FNT) in the soil, water, and food products has harmful effects on non-target organisms. Therefore, this study was conducted to evaluate the hepatotoxic, nephrotoxic and neurotoxic effects of FNT and the possible ameliorative effect of N-acetylcysteine (NAC), a precursor of intracellular GSH, on FNT-induced toxicity. For this purpose, thirty-two adult male albino rats were allocated into control group and groups treated with NAC (200 mg/kg), FNT (10 mg/kg) and FNT + NAC via gastric tube daily for 28 days. FNT intoxication significantly reduced food intake, water intake, body weight, and body weight gain and altered the expression of phase I and phase II xenobiotic-metabolizing enzymes-cytochrome P450 (CYP1A1) and glutathione S-transferase (GSTA4-4). In hepatic, renal and brain tissues, FNT induced oxidative stress, hepatopathy, nephropathy, and encephalopathy, and significantly increased pro-inflammatory cytokines. Furthermore, FNT exposure significantly elevated the level of hepatic and renal injury biomarkers and significantly inhibited the brain acetylcholinesterase activity. Co-administration of NAC with FNT modulated most of these altered biochemical, oxidative and inflammatory markers and restored the xenobiotic-metabolizing enzymes expression and histological structures. Our study indicated the involvement of oxidative damage, inflammation, and alteration of xenobiotic-metabolizing enzymes expression in FNT-induced toxicity and revealed that they were significantly improved by NAC co-treatment. These findings suggest that NAC administration might protect against FNT-induced toxicity in non-target organisms, including humans.
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Affiliation(s)
- Azza A A Galal
- Department of Pharmacology, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44511, Egypt.
| | - Raghda A Ramadan
- Department of Pharmacology, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44511, Egypt
| | - Mohamed M M Metwally
- Department of Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44511, Egypt
| | - Sawsan M A El-Sheikh
- Department of Pharmacology, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44511, Egypt
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Triantafyllidou O, Sigalos G, Oikonomou I, Vlahos N. Ovarian granulosa cell tumor and clomiphene citrate resistance. A case report and review of the literature. JBRA Assist Reprod 2018; 22:381-384. [PMID: 30141889 PMCID: PMC6210623 DOI: 10.5935/1518-0557.20180056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Granulosa cell tumors (GCTs) account for less than 5% of all ovarian malignancies, occur in younger ages, are usually diagnosed in their early stages, and have a good prognosis. GCTs usually present with features of hyperestrogenism. This paper reports the unusual case of an adult with a GCT with manifestations including amenorrhea, mild hirsutism, infertility, clomiphene citrate (CC) resistance (CC), mildly elevated testosterone, high anti-Müllerian hormone (AMH) and normal estrogen levels. The patient was initially diagnosed with polycystic ovarian syndrome (PCOS), and after four attempts at ovarian stimulation she was diagnosed with CC resistance. The patient later underwent laparoscopic evaluation on account of a solid mass on her left ovary. The pathology report described it as a borderline adult type GCT and four weeks after surgery she had a positive pregnancy test. Twelve months after delivery, the patient had no obvious symptoms of disease and her menstrual cycle was normal. Serial measurements of serum inhibin B, AMH, estrogen, and testosterone levels were within normal range. In conclusion, the resistance to clomiphene manifested by the patient might be explained by a potential mechanism implicating inhibin B and AMH due to the presence of a GCT. Further studies are required to evaluate the role of AMH and Inhibin B in the mechanism of CC resistance in women with PCOS.
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Affiliation(s)
| | - George Sigalos
- Reproductive Medicine Unit, "Leto" Maternity Hospital, Athens, Greece
| | | | - Nikos Vlahos
- 2nd Department of Obstetrics and Gynecology, "Aretaieion" Hospital, University of Athens, Greece
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Nemati M, Nemati S, Taheri AM, Heidari B. Comparison of metformin and N-acetyl cysteine, as an adjuvant to clomiphene citrate, in clomiphene-resistant women with polycystic ovary syndrome. J Gynecol Obstet Hum Reprod 2017; 46:579-585. [PMID: 28698075 DOI: 10.1016/j.jogoh.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/23/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the effects of short- and long-term treatment with metformin and NAC, in an adjuvant to clomiphene citrate (CC), on the improvement of hormonal profile (SHBG, total testosterone, FBS, and fasting insulin) and fertility status in CC-resistant women with PCOS. MATERIALS AND METHODS One hundred and eight CC-resistant PCOS patients participated in the study and received either metformin (1500mg/day) or NAC (1800mg/day) with 100mg/day of CC for 8 and 12 weeks. Mean BMI, hirsutism score, LH/FSH ratio, endometrial thickness, mature follicle number, and serum concentrations of LH, FSH, E2, fasting insulin, total testosterone and FBS were evaluated before and after short- and long-term treatment. Furthermore, ovulation and pregnancy rates in the first and second cycles were also determined in treated patients. RESULTS There was no significant difference in all variables before and 8 weeks after treatment with metformin and NAC. The BMI- and insulin-lowering effects of metformin were significantly higher than NAC after long-term treatment. However, the reducing-effect of NAC on hirsutism score and FBS levels was significantly more than metformin after 12 weeks. Treatment with metformin and NAC significantly increased ovulation and pregnancy rates in CC-resistant PCOS patients. In the first and second cycles, ovulation and pregnancy rates in patients treated with NAC were slightly higher than those received metformin. CONCLUSIONS Compared with metformin, administration of NAC in an adjuvant to CC is recommended for improving of hormonal profile and treatment of anovulatory infertility in hyperinsulinemic patients especially women with PCOS who are CC-resistant.
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Affiliation(s)
- M Nemati
- Department of Obstetrics and Gynecology, Shahrekord University of Medical Science, P.O. Box 8813833435, Rahmatieh, Shahrekord, Iran.
| | - S Nemati
- Department of Nursing Health, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - A-M Taheri
- Department of Radiology, Shahrekord University of Medical Science, Shahrekord, Iran
| | - B Heidari
- Female Fertility Clinic, Infertility Research Center of Hazrat-e Zahra, Shahrekord University of Medical Science, Shahrekord, Iran
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Ong M, Peng J, Jin X, Qu X. Chinese Herbal Medicine for the Optimal Management of Polycystic Ovary Syndrome. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2017; 45:405-422. [DOI: 10.1142/s0192415x17500252] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a complex heterogeneous disorder characterized by androgen excess and ovulatory dysfunction; it is now known to be closely linked to metabolic syndrome. Recent research suggests that insulin resistance plays an important role in the pathogenesis of PCOS which may lead to the excessive production of androgens by ovarian theca cells. Currently there is no single drug that can treat both the reproductive and metabolic complications of the disorder. Existing pharmaceutical agents such as hormonal therapies have been associated with side effects and are not appropriate for PCOS women with infertility. Additionally, insulin sensitizing agents useful for treating the metabolic abnormalities in PCOS have limited efficacy for treating reproductive aspects of the disorder. Chinese herbal medicines have a long history of treating gynaecological problems and infertility and therefore may be a novel approach to the treatment of PCOS. Current research demonstrates that the compounds isolated from herbs have shown beneficial effects for PCOS and when combined in an herbal formula can target both reproductive and metabolic defects simultaneously. Therefore, further investigation into Chinese herbal medicine in the treatment of PCOS is warranted.
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Affiliation(s)
- Madeleine Ong
- School of Life Sciences, University of Technology Sydney, NSW 2007, Australia
| | - Jie Peng
- School of Life Sciences, University of Technology Sydney, NSW 2007, Australia
- Department of Gynaecology and Obstetrics, Suzhou Wuzhong People’s Hospital, Jiangsu Province, People’s Republic of China
| | - Xingliang Jin
- School of Life Sciences, University of Technology Sydney, NSW 2007, Australia
| | - Xianqin Qu
- School of Life Sciences, University of Technology Sydney, NSW 2007, Australia
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Twenty years of ovulation induction with metformin for PCOS; what is the best available evidence? Reprod Biomed Online 2015; 32:44-53. [PMID: 26656973 DOI: 10.1016/j.rbmo.2015.09.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 12/18/2022]
Abstract
The potential reproductive benefits of metformin, a drug endowed with the capacity to ameliorate insulin resistance in polycystic ovary syndrome (PCOS), has garnered much interest over the past 2 decades. In this review, randomized-controlled trials (RCT) and meta-analyses of RCT comparing metformin are critically appraised and summarized. PubMed and CENTRAL databases were consulted. Evidence is insufficient to favour the use of metformin or metformin plus clomiphene citrate instead of clomiphene citrate for ovulation induction in women with newly diagnosed PCOS. Evidence is also insufficient to recommend metformin as a primary treatment for non-obese women with PCOS. Metformin plus clomiphene citrate should be considered as an effective option in clomiphene citrate-resistant PCOS. In women with PCOS undergoing gonadotrophin ovulation induction, metformin significantly increased pregnancy and live birth rates (P < 0.0001 and P = 0.020, respectively) with reduced risk of cancelled cycles. A beneficial effect of metformin co-treatment in increasing clinical pregnancy rates and reducing the risk of OHSS in PCOS patients undergoing assisted reproduction techniques has been shown. No evidence was found of reduced risk of spontaneous abortion or increased risk of major anomalies in women with PCOS taking metformin during the first trimester.
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Abu Hashim H, Foda O, Ghayaty E. Combined metformin-clomiphene in clomiphene-resistant polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand 2015; 94:921-30. [DOI: 10.1111/aogs.12673] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 05/06/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Hatem Abu Hashim
- Department of Obstetrics & Gynecology; Faculty of Medicine; Mansoura University; Mansoura Egypt
| | - Osama Foda
- Department of Internal Medicine; Endocrinology Unit; Faculty of Medicine; Mansoura University; Mansoura Egypt
| | - Essam Ghayaty
- Department of Clinical Pharmacology; Faculty of Medicine; Mansoura University; Mansoura Egypt
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