FSH and AMH

•This 2023 meta-analysis, researchers evaluated the clinical efficacy of acupuncture for the treatment of diminished ovarian reserve (DOR) based on the existing multiple randomized controlled trials. Common markers were analyzed including sex hormones level and antral follicle count (AFC). Researchers reviewed and analyzed whether acupuncture produced significant changes in subjects’ hormones, i.e. decreasing follicle-stimulating hormone (FSH) levels and increasing anti-Müllerian hormone (AMH) levels. It was found that acupuncture consistently provided sought after results in both FSH and AMH hormone levels. Compared with electro-acupuncture treatment, researchers found manual acupuncture was superior in reducing FSH levels, FSH/luteinizing hormone (LH) ratio, and increasing AMH levels and AFC. Researchers concluded that acupuncture may have significant clinical potential for treating patients with DOR. 86

• In this limited study, researchers studied 32 patients with diminished ovarian reserve (DOR) to evaluate the clinical effect of acupuncture at "thirteen acupoints for regulating menstruation and promoting pregnancy". Researchers wanted to learn the effects of acupuncture and its influence on ovarian reserve function. Participants in this study were followed for 3 months, receiving various acupuncture treatments at regular intervals, depending on the group to which they were assigned. Researcher found that after treatment, the levels of follicle stimulating hormone (FSH), FSH/ luteinizing hormone (LH) were lower than before treatment, ovarian peak systolic velocity was higher than before treatment, resistive index was lower than before treatment, and astral follicle count was more than before treatment. Researchers concluded that Acupuncture at "thirteen acupoints for regulating menstruation and promoting pregnancy" can effectively improve the ovarian reserve function of DOR patients.85

• In this study, researchers wished to observe the clinical effect of acupuncture plus medication in the treatment of poor ovarian response (POR) patients and to explore its mechanisms in assisting pregnancy. The researchers enrolled 100 volunteer POR women who were also undergoing in vitro fertilization-embryo transplantation (IVF-ET). After a first round to establish control, the women were randomly divided into control, medication (Climen, composed of estradiol valerate and cyproterone acetate), acupuncture alone, and acupuncture plus medication groups. A protocol was established that could be properly tracked and noted. Researchers tracked serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2), as well as serum anti-mullerian hormone (AMH) and a colour doppler ultrasonic apparatus was used to examine astral follicle counts. Researchers determined that the combined acupuncture and medication groups were better than the control group, the acupuncture alone group, and the medication alone group for relevant markers. Researchers concluded that Acupuncture combined with medication improves the level of endocrine hormones and ovarian reservation function in POR women undergoing IVF-ET, benefiting the ovary environment of pregnancy. 84

• Researchers wished to investigate whether electro-acupuncture or physical exercise influence serum anti-Müllerian hormone (AMH), antral follicle count (AFC) or ovarian volume in women with polycystic ovary syndrome (PCOS). Seventy-four women with PCOS recruited from the general population. Women with PCOS were randomized to 16 weeks of electro-acupuncture (14 treatments), exercise (at least three times/week), or no intervention. Researchers in this study were the first to demonstrate that acupuncture reduces serum AMH levels and ovarian volume. Physical exercise did not influence circulating AMH or ovarian volume. Despite a within-group decrease in AFC, exercise did not lead to a between-group difference. 69

• The aim of this study was to investigate the effect of transcutaneous electrical acupoint stimulation (TEAS) on ovarian reserve in patients with diminished ovarian reserve undergoing in vitro fertilization and embryo transfer. A total of 240 patients were randomly divided into the Han’s acupoint nerve stimulator TEAS treatment (TES), comforting false Han’s placebo (FHP), artificial endometrial cycle treatment (AEC), and control (CON) groups. Researchers concluded TEAS and AEC treatments could improve basal endocrine levels in patients, and increase the number of oocytes retrieved and high-quality embryos. TEAS treatment could improve the clinical pregnancy rate in patients with decreased ovarian reserve during in vitro fertilization and embryo transfer cycles.82

• Others have studied acupuncture treatment for polycystic ovary syndrome (PCOS). Anti-müllerian hormone (AMH) is positively correlated with the ovarian follicle pool, thus making it a useful ovarian reserve measure. AMH is elevated in women with PCOS and has been suggested as a diagnostic tool. This study examined the impact of electroacupuncture on AMH concentration in women with PCOS. Seventy-one women with PCOS participated in a randomized, double-blind, sham-controlled clinical trial of acupuncture. Three longitudinal AMH samples over the 5-month protocol were compared with objective ovulation parameters primarily using nonparametric statistics. Results indicated that AMH levels in PCOS were higher than published norms in women without PCOS. In conclusion, AMH correlated with an increased likelihood of monthly ovulation, as expected from the literature on women without PCOS. The lack of difference by intervention in AMH was consistent with the underlying clinical trial. AMH may be clinically useful to predict which PCOS women are more likely to respond to an intervention. 59

• The purpose of this study was to explore the clinical efficacy and action mechanism of acupuncture for premature ovarian failure (POF). Acupuncture was applied to participants, three times per week and 3 months were considered as one session. Totally two sessions were performed. The menstruation condition, estradiol (E2), follicle-stimulating hormone (FSH) and scores of the clinical perimenopausal symptoms were taken as treatment outcomes. The researchers concluded that acupuncture has certain effect on improving menstruation and perimenopausal symptoms in POF patients, which is likely related to increasing the level of E2. 67

• Researchers investigated the effect of acupuncture on women with premature ovarian failure (POF). All patients were treated with acupuncture once every other day, three times a week for three months. Acupoints, GV 20, GV 24, GB 13, CV 3, CV 4, BL 23, BL 32, ST 25, ST 28, ST 29, ST 36, SP 6, KI 3, and LR 3, were selected. Serums FSH, E2, and LH level, Self-Rating Anxiety Scale (SAS), and Kupperman score were measured at baseline and at the end of treatment; the menstrual cycle was recorded during one-month follow-up. Compared with baseline, patients’ serums FSH and LH were decreased, E2 was increased, and SAS score and Kupperman score were decreased. Four patients resumed menstrual cycle after treatment and two resumed during follow-up. No serious adverse events were found in all patients. The results indicate that acupuncture may decrease serums FSH and LH level, raise serum E2 level, relieve anxiety, reduce mental stress, and improve the menopausal symptoms, with no adverse side effects. 68