Polycystic Ovary Syndrom (PCOS)

• This study, conducted by neuroscientists in Stochholm, Sweden, aimed to determine whether low-frequency electro-acupuncture (EA) would benefit Polycystic ovary syndrome (PCOS) by decreasing hyperandrogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention. Scientists randomized 84 women with PCOS, aged 18-37 yr, to 16 wk of low-frequency EA, physical exercise, or no intervention. The primary outcome measure changes in the concentration of total testosterone (T) at week 16. Secondary outcome measures were changes in menstrual frequency; concentrations of androgens, estrogens, androgen precursors, and glucuronidated androgen metabolites; and acne and hirsutism. Both acupuncture and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-wk follow-up compared with no intervention. Low-frequency electro-acupuncture and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Conclusion: Low-frequency electro-acupuncture was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.2

• A clinical and experimental study of integrated traditional Chinese and western medicine in the past 45 years. The study included observations on the induction of ovulation with acupuncture, and the treatment of polycystic ovary syndrome (PCOS) using acupuncture and herbal remedies. Acupuncture and herbs successfully promoted ovulation, affected serum FSH, and resolved the PCOS, resulting in ovulation.11

• This study was designed to evaluate if electro-acupuncture (EA) could affect oligo-/anovulation and related endocrine and neuroendocrine parameters in women with polycystic ovary syndrome (PCOS). Repeated EA treatments induced regular ovulations in more than one third of the women with PCOS. Electro-acupuncture offers an alternative to pharmacological ovulation induction.12

• The researchers in this study looked at one group of women with polycystic ovary syndrome who received a specific type of acupuncture called “electro-acupuncture” for four months. A second group of women were provided with heart rate monitors and instructed to exercise at least three times a week. A third group received no intervention. The study showed that activity in the sympathetic nervous system was lower in the women who received acupuncture and in those who took regular exercise than it was in the control group. The acupuncture treatment brought further benefits. Those who received acupuncture found that their menstruation became more “normal”. In addition, those that received acupuncture had their levels of testosterone reduced significantly. This is important because elevated testosterone levels are closely connected with the increased activity in the sympathetic nervous system of women. The researchers concluded that acupuncture and exercise can bring relief to women with polycystic ovary syndrome (PCOS).16

• The aim of this study was to review studies on acupuncture in reproductive medicine, in experimental and clinical settings. Studies suggest that acupuncture effects are mediated by changes in activity of the autonomic nervous system and stimulation of neuropeptides/neurotransmitters which may be involved in the pathogenesis of infertility. This study found there is evidence of benefit mainly when acupuncture is performed on the day of embryo transfer (ET) in the live birth rate. There was also found to be benefit when acupuncture is performed for female infertility due to polycystic ovary syndrome (PCOS). There is evidence of sperm quality improvement when acupuncture is performed on males affected by idiopathic infertility. Conclusions: Acupuncture seems to have beneficial effects on live birth rate when performed on the day of ET, and to be useful also in PCOS as well as in male idiopathic infertility, with very low incidence of side effects.18

• This study aimed to provide a literature review on evaluating the efficacy of acupuncture therapy in the treatment of polycystic ovarian syndrome (PCOS) and also to determine the possible mechanism of acupuncture treatment in PCOS. Four studies were recruited. Several studies showed that acupuncture significantly increases beta-endorphin levels for periods up to 24 h and may have regulatory effect on FSH, LH and androgen. beta-endorphin increased levels secondary to acupuncture affects the hyperthalamic-pituitary-adrenal (HPA) axis through promoting the release of ACTH through stimulation of its precursor pro-opiomelanocortin synthesis. Conclusion: Acupuncture is a safe and effective treatment to PCOS as the adverse effects of pharmacologic interventions are not expected by women with PCOS. Acupuncture therapy may have a role in PCOS by: increasing of blood flow to the ovaries, reducing of ovarian volume and the number of ovarian cysts, controlling hyperglycaemia through increasing insulin sensitivity and decreasing blood glucose and insulin levels, reducing cortisol levels and assisting in weight loss and anorexia.44

• Some evidence suggests there are beneficial effects of acupuncture on in vitro fertilisation (IVF) success rate. However, recent clinical trials could not duplicate these effects, especially in patients who are infertile with polycystic ovarian syndrome (PCOS) who are undergoing IVF. The aim of this study is to determine if acupuncture has an effect on IVF success rates in women with PCOS.

• Different mechanisms have been described for the effects of acupuncture on fertility. Acupuncture may mediate neurotransmitter release, which results in the stimulation of gonadotrophin-releasing hormone secretion. The production of neurotransmitters such as endogenous opioids may also inhibit central nervous system outflow and biological stress response. Acupuncture may also stimulate blood flow to the uterus by inhibiting uterine central sympathetic nerve activity. The researchers results showed a statistically higher mean of good quality embryos in group I compared with group II (p=0.044). Conclusion: Acupuncture at an early stage of oocyte recruitment may have a beneficial effect on embryo quality. 46

• Researchers attempted to answer the question of which therapy is the best therapy for infertility caused by polycystic ovary syndrome (PCOS). One hundred and twenty patients were randomized into three groups, a clomi-phene group, an acupuncture-moxibustion + Chinese medicine group and a clomiphene + acupuncture-moxibustion+ Chinese medicine group. The endometrial thickness, endometrial type and cervical mucus score on human chorionic gon adotropin (HCG) day, and ovulatory cycle rate, clinical pregnancy rate and abortion rate after treatment were observed in the patients of the three groups. Conclusions: The combined therapy of acupuncture, herbal medicine and clomiphene improves the pregnancy rate and reduces early abortion rate by effectively improving HCG day cervical mucus, endometrial thickness and morphology. The efficacy is apparently superior to the simple medication with clomiphene and the combined application of acupuncture and herbal medicine.66

• The aim of this study was to observe the effect of electroacupuncture (EA) treatment on the quality of ovum, stem cell factor (SCF) and pregnancy outcome in patients with polycystic ovarian syndrome (PCOS), so as to explore its underlying mechanism, improving pregnancy rates. A total of 200 PCOS patients undergoing in vitro fertilization-embryo transplantation (IVF-ET) were randomly divided into control (medication) group (n = 98) and EA group (n = 102). Comparison between the two groups showed that the high quality embryo rate, and serum and follicular fluid SCF contents were significantly higher in the EA group than in the medication group (P 0.05, P 0.01). A positive correlation was found between the high quality embryo rate and the SCF level in both follicular fluid and serum (P < 0.01). Researchers concluded that EA can improve high quality embryo rates, which may be related to its effect in increasing serum and follicular fluid SCF levels.81

• The aim of this prospective, randomized, controlled clinical trial 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. Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome (PCOS). 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. Researchers concluded 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.83

• PCOS, the most prevalent endocrine disorder in women, is marked by polycystic ovaries, chronic anovulation, and hyperandrogenism. Current treatment focuses on managing symptoms through lifestyle changes and medications like Metformin, oral contraceptives, and antiandrogens. However, effectively addressing the outcomes of PCOS remains challenging. Researchers conducted a review to explore the latest pharmacotherapeutic and non-pharmacotherapeutic interventions aimed at addressing various symptomatic challenges associated with PCOS. They discussed acupuncture and PCOS as follows. Acupuncture is an ancient therapy that uses needles to stimulate nerves in the skin and muscles. It has gained popularity globally for its potential benefits in reproduction and endocrinology. Studies suggest that acupuncture may be useful in addressing issues such as anovulatory dysfunction, insulin resistance, and hyperandrogenism in polycystic ovary syndrome (PCOS). Research indicates that acupuncture can regulate the hypothalamic-pituitary-ovarian axis, potentially improving hormonal and metabolic profiles in cases of hyperandrogenism. In a randomized controlled trial involving overweight/obese PCOS patients, electroacupuncture over a 5-week period improved glucose tolerance and reduced adipose tissue androgens. Additionally, studies on rat PCOS models have shown that electroacupuncture is more effective in enhancing insulin sensitivity compared to exercise. Recent findings suggest that acupuncture may also alleviate anxiety and depression in PCOS by decreasing serum β-endorphin and androgen levels. Nevertheless, more rigorous clinical and preclinical studies, incorporating high-quality systematic research, are needed to provide stronger evidence for the treatment of PCOS.87