Effect of Myoinositol in Combination with Alpha- Lipoic Acid and N-acetylcysteine (Celine®) on Ovulation and Pregnancy Rates in Clomiphene- Resistant Women with Polycystic Ovarian Syndrome: A Prospective Chart Review
Jehan Elfarjani and Patrick Choueiry
Introduction: Polycystic ovarian syndrome (PCOS) is often accompanied by anovulatory infertility in
women and contributes to lower pregnancy rates and an increased risk of miscarriage. While clomiphene
citrate (CC) is the first line treatment for ovulation induction, CC resistance develops in 15 to 40% of
women with PCOS. Emerging studies suggest that insulin-sensitizing agents such as myo-inositol (MI),
N-acetyl-cysteine (NAC), and α-Lipoic acid (ALA) can improve ovulation and pregnancy rates.
Objectives: This prospective chart review aimed to evaluate the efficacy of Celine®, an insulinsensitizing agent containing MI, NAC, and ALA, in improving ovulation and pregnancy rates in CCresistant women with PCOS.
Methods: Data were extracted from the medical records of one hundred women with CC-resistant
polycystic ovarian syndrome who were initiated on Celine®. Of the main population, 63 women who
remained anovulatory after two menstrual cycles were subsequently prescribed CC in addition to
Celine®. Cumulative ovulation and pregnancy rates were calculated based on all ovulations/clinical
pregnancies achieved after the first Celine® cycle (n=100) and after the second cycle of Celine® + CC
(n=63).
Results: Spontaneous ovulation occurred in 37% with Celine® alone and 45% with Celine® + CC,
yielding a cumulative ovulation rate of 82%. Clinical pregnancy rates were 18% and 17%, respectively,
with a cumulative rate of 43%.
Conclusions: The addition of Celine®, alone or in combination with CC, to the treatment of PCOS in
women with CC resistance improved ovulation and pregnancy rates, highlighting its potential role in
enhancing reproductive outcomes.
