Trials examining the effect of acupuncture on ovary function of women with PCOS are being carried out in many centres in the world. The effect of Chinese herbs has also been studied with relation to hormonal factors and obesity.


Autonomic nervous system activation mediates the increase in whole-body glucose uptake in response to electroacupuncture

Anna Benrick et al, FASEB Journal,  April 12, 2017, doi: 10.1096/fj.201601381R

Foundation of American Experimental Biology Journal

This study explores the underlying mechanism for electroacupuncture and its use in PCOS. The results indicate that applying just one session of low frequency electroacupuncture can reduce blood sugar in overweight women with PCOS. This adds to the mounting evidence that electroacupuncture could be a valid treatment option for some PCOS patients.

Conclusions on clinical application will await an RCT.

Abstract

A single bout of low-frequency electroacupuncture (EA) causing muscle contractions increases whole-body glucose uptake in insulin-resistant rats. We explored the underlying mechanism of this finding and whether it can be translated into clinical settings.

Changes in glucose infusion rate (GIR) were measured by euglycemic–hyperinsulinemic clamp during and after 45 min of low-frequency EA in 21 overweight/obese women with polycystic ovary syndrome (PCOS) and 21 controls matched for age, weight, and body mass index (experiment 1) and in rats receiving autonomic receptor blockers (experiment 2).

GIR was higher after EA in controls and women with PCOS. Plasma serotonin levels and homovanillic acid, markers of vagal activity, decreased in both controls and patients with PCOS. Adipose tissue expression of pro-nerve growth factor (proNGF) decreased, and the mature NGF/proNGF ratio increased after EA in PCOS, but not in controls, suggesting increased sympathetic-driven adipose tissue metabolism.

Administration of α-/β-adrenergic receptor blockers in rats blocked the increase in GIR in response to EA. Muscarinic and dopamine receptor antagonist also blocked the response but with slower onset.

In conclusion, a single bout of EA increases whole-body glucose uptake by activation of the sympathetic and partly the parasympathetic nervous systems, which could have important clinical implications for the treatment of insulin resistance.


Herbal Medicines for Treating Metabolic Syndrome: A Systematic Review of Randomized Controlled Trials

Jang et al, Evid Based Complement Alternat Med. 2016:5936402

Evidence Based Complementary and Alternative Medicine

One of the concerns of many overweight or PCOS patients is elevated insulin levels and abdominal obesity, such as is seen in metabolic syndrome.  A reduction in these is correlated with better ovary function in these patients. This systematic review examines the effect of Chinese herbs on such parameters and concluded that they could contribute to clinical management.

Abstract

Objective. The aim of this systematic review is to evaluate the efficacy and safety of herbal medicines in the management of metabolic syndrome. Materials and Methods. On December 9, 2015, we searched PubMed, EMBASE, Cochrane Library, SCOPUS, AMED, CNKI, KoreaMed, KMBASE, OASIS, and J-STAGE with no restriction on language or published year. We selected randomized controlled trials that involved patients with metabolic syndrome being treated with herbal medicines as intervention. The main keywords were “Chinese herbal medicines”, “metabolic syndrome”, and “randomized controlled trials”. Herbal substances which were not based on East Asian medical theory, combination therapy with western medicines, and concurrent diseases other than metabolic syndrome were excluded. The risk of bias was assessed by Cochrane’s “Risk of Bias” tool. The protocol or review was registered in PROSPERO (an international prospective register of systematic reviews) (CRD42014006842).

Results. From 1,098 articles, 12 RCTs were included in this review: five trials studied herbal medicines versus a placebo or no treatment, and seven trials studied herbal medicines versus western medicines. Herbal medicines were effective on decreasing waist circumference, blood glucose, blood lipids, and blood pressure.

Conclusion. This study suggests the possibility that herbal medicines can be complementary and alternative medicines for metabolic syndrome.


Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis

Junyoung Jo and  Yoon Jae Lee, 2017 Acup in Med, Vol: 35 issue: 3, 162-170

British Medical Journal; Acupuncture in Medicine

This systematic review of randomised controlled trials examined the effect of acupuncture on 430 PCOS patients undergoing IVF, The findings indicate that acupuncture (both electro acupuncture and manual acupuncture) improves pregnancy rates and reduces the risk of OHSS. Acupuncture was delivered only during the IVF cycle and did not improve live birth outcomes in this review. Further studies are recommended to examine the efficacy and safety of acupuncture in PCOS patients doing IVF.

Abstract

Objectives The aim of this systematic review was to assess the evidence from randomised controlled trials (RCTs) on the efficacy, effectiveness and safety of acupuncture in women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

Methods We searched a total of 15 databases through October 2015. The participants were women with PCOS (diagnosed using the Rotterdam criteria) undergoing IVF or ICSI. Eligible trials were those with intervention groups receiving manual acupuncture (MA) or electroacupuncture (EA), and control groups receiving sham acupuncture, no treatment or other treatments. Outcomes included the clinical pregnancy rate (CPR), live birth rate (LBR), ongoing pregnancy rate (OPR) and incidence of ovarian hyperstimulation syndrome (OHSS) and adverse events (AEs). For statistical pooling, the risk ratio (RR) and its 95% (confidence interval) CI was calculated using a random effects model.

Results Four RCTs including 430 participants were selected. All trials compared acupuncture (MA/EA) against no treatment. Acupuncture significantly increased the CPR (RR 1.33, 95% CI 1.03 to 1.71) and OPR (RR 2.03, 95% CI 1.08 to 3.81) and decreased the risk of OHSS (RR 0.63, 95% CI 0.42 to 0.94); however, there was no significant difference in the LBR (RR 1.61, 95% CI 0.73 to 3.58). None of the RCTs reported on AEs.

Conclusions Acupuncture may increase the CPR and OPR and decrease the risk of OHSS in women with PCOS undergoing IVF or ICSI. Further studies are needed to confirm the efficacy and safety of acupuncture as an adjunct to assisted reproductive technology in this particular population.


Effectiveness of Abdominal Acupuncture for Patients with Obesity-Type Polycystic Ovary Syndrome: A Randomized Controlled Trial

Zheng YH et al, Jnl of Alt and Comp Med, 2013 Sep;19(9):740-5.
The Journal of Alternative and Complementary Medicine  

In this RCT 86 overweight PCOS patients were divided into acupuncture or Metformin groups and treated for 6 months before assessing a range of outcomes. While both groups improved, the acupuncture group responded significantly better than those given Metformin  in terms of increased frequency of ovulation and weight loss.

Abstract

Objective: To assess the effectiveness of abdominal acupuncture at the endocrine and metabolic level in patients with obesity-type polycystic ovary syndrome (PCOS).

Methods: Eighty-six women from the First Affiliated Hospital of Guangzhou Medical College with a diagnosis of PCOS (body–mass index [BMI] ≥25 kg/m2) were randomly assigned to receive 6 months of abdominal acupuncture (twice a week) or oral metformin (250 mg three times daily in the first week, followed by 500 mg three times daily thereafter).

BMI, waist-to-hip ratio (WHR), ovarian volume, menstrual frequency, homeostasis model assessment for insulin resistance (HOMA-IR), and Ferriman–Gallwey score were measured at the beginning of the study and after 6 months of treatment. Luteotrophic hormone (LH), testosterone, follicle-stimulating hormone (FSH), fasting blood glucose, 2-hour Postprandial blood glucose, fasting insulin, 2-hour postprandial blood insulin, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were also assessed.

Results: According to the results at baseline and 6 months, BMI, WHR, Ferriman–Gallwey score, ovarian volume, luteotrophic hormone, ratio of luteotrophic hormone to follicle-stimulating hormone, testosterone, LDL-C, triglycerides, total cholesterol, fasting blood glucose, 2-hour postprandial blood glucose, fasting insulin, 2-hour postprandial blood insulin, and HOMA-IR were reduced significantly in the two groups (p<0.05).

Menstrual frequency and HDL-C (p<0.05) increased significantly in both groups; follicle-stimulating hormone also increased in both groups, but the change was not significant (p>0.05). The acupuncture group showed considerable advantages over the metformin group in terms of reduced BMI and WHR and increases in menstrual frequency (p<0.05).

Conclusion: Abdominal acupuncture and metformin improved the endocrine and metabolic function of patients with obesity-type PCOS. Abdominal acupuncture may be more effective in improving menstrual frequency, BMI, and WHR, with few adverse effects.


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

 Johansson J et al, Am J Physiol Endocrinol Metab. 2013 May 1;304(9):E934-43
American Journal of Physiology – Endocrinology and Metabolism 

This RCT showed that repeated acupuncture treatments increased ovulation frequency in PCOS patients and abnormally high ovarian and adrenal hormone levels were reduced, compared to controls subjects who had no acupuncture. Larger trials are needed to confirm this result.

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 luteinizing hormone (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 in combination with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10-13 weeks.

Main outcome measures were changes in LH secretion patterns from baseline to after 10-13 weeks 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 compared with the control group. After 10-13 weeks of intervention, circulating levels of estrone, estrone sulfate, estradiol, dehydroepiandrosterone, dehydroepiandrosterone-sulfate, androstenedione, testosterone, free-testosterone, dihydrotestosterone, androsterone glucuronide, androstane-3α, 17β-diol-3glucuronide, and androstane-3α, 17β-diol-17glucuronide 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.


Impact of EA and physical exercise on hyperandrogenism and oligo/amenorrhea in women with PCOS.

Jedel E et al, Am J Physiol Endocrinol Metab 2011 300:(1) E37-E45
American Journal of Physiology

This small RCT found that 4 months of electro-acupuncture effectively reduced testosterone and improved ovulation frequency in PCOS patients, and was superior to exercise in achieving these aims.

Abstract

Polycystic ovary syndrome (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by hyperandrogenism, oligo/amenorrhea, and polycystic ovaries. We aimed to determine whether low-frequency electro-acupuncture (EA) would decrease hyperandrogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention.

We 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 16determined by gas and liquid chromatography-mass spectrometry was analyzed by intention to treat. Secondary outcome measures were changes in menstrual frequency; concentrations of androgens, estrogens, androgen precursors, and glucuronidated androgen metabolites; and acne and hirsutism. Outcomes were assessed at baseline, after 16 wk of intervention, and after a 16-wk follow-up. After 16 wk of intervention, circulating T decreased by −25%, androsterone glucuronide by −30%, and androstane-3α,17β-diol-3-glucuronide by −28% in the EA group (P = 0.038, 0.030, and 0.047, respectively vs. exercise); menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group (P = 0.018 vs. exercise). After the 16-wk follow-up, the acne score decreased by −32% in the EA group (P = 0.006 vs. exercise).

Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16and at the 16-wk follow-up compared with no intervention. Low-frequency EA and physical exercise improved hyperandrogenism and menstrual frequency more effectively than no intervention in women with PCOS. Low-frequency EA was superior to physical exercise and may be useful for treating hyperandrogenism and oligo/amenorrhea.