Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial

Abstract

Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome (PCOS). Our aim was to investigate whether acupuncture affects ovulation frequency and to understand the underlying mechanisms of any such effect by analyzing LH and sex steroid secretion in women with PCOS. This prospective, randomized, controlled clinical trial was conducted between June 2009 and September 2010. Thirty-two women with PCOS were randomized to receive either acupuncture with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10 -13 wk. Main outcome measures were changes in LH secretion patterns from baseline to after 10 -13 wk of treatment and ovulation frequency during the treatment period. Secondary outcomes were changes in the secretion of sex steroids, anti-Müllerian hormone, inhibin B, and serum cortisol. Ovulation frequency during treatment was higher in the acupuncture group than in the control group. After 10 -13 wk of intervention, circulating levels of estrone, estrone sulfate, estradiol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, testosterone, free testosterone, dihydrotestosterone, androsterone glucuronide, androstane-3␣,17␤-diol-3-glucuronide, and androstane-3␣,17␤-diol-17-glucuronide decreased within the acupuncture group and were significantly lower than in the control group for all of these except androstenedione. We conclude that repeated acupuncture treatments resulted in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist. Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion. polycystic ovary syndrome; acupuncture; ovulation; lh pulsatility; sex steroids THE MAIN CHARACTERISTICS of polycystic ovary syndrome (PCOS) are polycystic ovaries (34), oligo/anovulation, and elevated serum levels of sex steroid precursors, estrogens, androgens, and glucuronidated androgen metabolites (38). PCOS is related to hyperinsulinemia and insulin resistance and is exacerbated by obesity (7). Numerous studies have reported hypersecretion of luteinizing hormone (LH) in women with PCOS (3). Together with an exaggerated ovarian response, hypersecretion of LH drives excessive ovarian androgen production and causes anovulation (13). In PCOS, altered sex steroid production, metabolic dysfunction, and obesity all contribute to changes in LH secretion patterns and to anovulation (6,12,29,30).Clomiphene citrate, exogenous gonadotropin therapy, and laparoscopic ovarian drilling are commonly used to induce ovulation in women with PCOS (1). These treatments often have negative side effects, thus indicating the importance of evaluating alternative treatments such as acupuncture. Acupuncture is used worldwide to achieve fertility, but its efficacy is supported by only limited scientific evidence. In a randomized controlled trial (RCT), we previously demonstrated that acupuncture w...

Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome

“…Before this study, 2 trials demonstrated that acupuncture was effective for ovulation induction compared with no treatment or regularly meeting with a therapist. 13,14 The only shamcontrolled trial using a nonpenetrating sham was underpowered for investigating live births, 8 but it found ovulation rates between active and control acupuncture similar to those observed in this study. That study used the nonpenetrating Streitberger placebo needle, 28 whereas superficial needle placement was used as a control in this study.…”

“…29 The ovulation rates in the active and control acupuncture groups in this trial were higher than rates in trials with a no-intervention control group. 13,14 Thus, the acupuncture procedure, unrelated to needle placement or stimulation, may have placebo effects. There was no statistically significant difference between active and control acupuncture in clinical or biochemical variables or serious adverse events.…”

Use of electroacupuncture and transcutaneous electrical acupoint stimulation in reproductive medicine: a group consensus

“…The vital acupoints include Guanyuan (CV 4), Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), and Sanyinjiao (SP 6). In addition, acupoints in other meridians, such as Zigong (EX-CA1) and Taichong (LR 3), are also commonly used in clinical practice (Cui et al, 2011;Johansson et al, 2013;Lei and Feng, 2014).…”

“…Acupuncture has been used in treating gynecological and reproductive disorders for thousands of years (Zhou and Qu, 2009). Electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS), the modern therapies derived from traditional acupuncture, have received increasing attention in recent years (Han and Ho, 2011;Johansson et al, 2013). The present group consensus is intended to provide guidelines for physicians and practitioners using EA or TEAS in the treatment of reproductive disorders (Li et al, 2016).…”

Effectiveness of Acupuncture in Women with Polycystic Ovarian Syndrome Undergoing in Vitro Fertilisation Or Intracytoplasmic Sperm Injection: A Systematic Review and Meta-Analysis

“…Several clinical studies have indicated that acupuncture improves ovulatory dysfunction and insulin sensitivity, and decreases testosterone, in patients with PCOS. [8][9][10] Given that women with PCOS undergoing ovarian stimulation are considered to be at increased risk for OHSS, it is important to confirm the effects and safety of acupuncture as an adjunct treatment in this particular population, to maximise the success rates of IVF or ICSI.…”