The Effect of N‐Acetyl Cysteine on Serum Lipid Profile and Heavy Metals in Women With Endometriosis Undergoing ICSI: A Randomized Controlled Trial

Background and Aims Endometriosis is associated with oxidative stress and heavy metal accumulation. This study evaluated whether N‐acetylcysteine (NAC) reduces serum heavy metals and improves lipid profiles in women with endometriosis undergoing fertility treatment. Methods In this randomized controlled trial, 60 women with laparoscopy‐confirmed endometriosis were allocated to NAC (1.8–3 g/day, increased to 3 g/day in participants with BMI ≥ 25 kg/m) or control groups for 6 weeks. Serum levels of lead, cadmium, nickel, chromium, and lipid profiles were measured using atomic absorption spectroscopy and enzymatic assays. Primary outcomes were heavy metal changes; secondary outcomes were lipid profile alterations. Results Baseline characteristics were comparable between groups. After 6 weeks, NAC significantly reduced serum lead (MD −0.6 μg/dL; Cohen's d = 0.62; p = 0.03) and nickel (MD −0.8 μg/dL; Cohen's d = 0.59; p = 0.04), both with medium effect sizes. Cadmium and chromium changes were not significant. NAC also significantly reduced total cholesterol (MD −28.4 mg/dL; Cohen's d = 2.01; p < 0.001) and triglycerides (MD −19.7 mg/dL; Cohen's d = 1.45; p < 0.001), representing large effects. HDL decreased modestly (MD −5.2 mg/dL; Cohen's d = 0.89; p = 0.001), with no significant change in LDL. Conclusion NAC supplementation was associated with reduced serum lead and nickel concentrations and improved lipid parameters in women with endometriosis undergoing ICSI. However, the observed reduction in HDL cholesterol warrants cautious interpretation, and further studies are required to confirm these findings and clarify their clinical significance.