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Wang M et al., 2015) (Figure 2)

Maternal undernutrition during pregnancy alters amino acid metabolism and gene expression associated with energy metabolism and angiogenesis in fetal calf muscle

Dietary methionine receives an adenosyl group from ATP to form S-adenosyl-L-methionine (SAM)

36 A better understanding of NACs role in modulating these measures after oral dosing is required to address this concern

However, a Cochrane systematic review encompassing five randomized controlled trials (415 women) found insufficient very low-quality evidence to support its effectiveness in improving clinical pregnancy rate (RR 1.38, 95% CI 0.91 to 2.10), live birth rate, overall pain, miscarriage rate (Peto OR 1.99, 95% CI 0.20 to 19.37), or endometriosis recurrence (RR 0.84, 95% CI 0.30 to 2.36), highlighting the need for higher-quality trials (65)