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Abstract
Polycystic ovary syndrome (PCOS) is a heterogeneous reproductive, endocrine, and metabolic disorder in which autonomic, neuroendocrine, inflammatory, and metabolic abnormalities may converge on ovarian and endometrial function. This narrative review evaluates evidence relevant to acupuncture in PCOS, with emphasis on evidence source, directness, and clinically meaningful reproductive outcomes. PubMed, Embase, and Web of Science were searched from inception to March 31, 2026, supplemented by backward citation tracking. We prioritized human PCOS trials and mechanistic studies, followed by PCOS-specific preclinical evidence; findings from other conditions were included only as explicitly labeled indirect evidence. No formal risk-of-bias assessment or meta-analysis was undertaken. Clinical evidence most consistently suggests possible effects on menstrual or ovulatory function, sympathetic activity, and insulin resistance, although results vary across protocols and PCOS phenotypes. Evidence for pregnancy, ongoing pregnancy, embryo quality, and live birth remains limited and inconsistent, and acupuncture has not been established as a substitute for guideline-based fertility treatment. Human data directly linking acupuncture to immune-cell reprogramming, endometrial immune tolerance, or correction of window-of-implantation timing are scarce. PCOS-specific animal studies provide plausible signals involving hypothalamic-pituitary-ovarian regulation, ovarian sympathetic signaling, inflammatory pathways, oxidative stress, and insulin signaling, but these findings cannot be assumed to translate to clinical reproductive benefit. Overall, the neuroendocrine-immune framework is best viewed as a hypothesis-guiding map that distinguishes relatively supported clinical domains from preclinical and indirect mechanisms. Future trials should combine standardized acupuncture protocols with phenotype stratification, prespecified ovulation, ongoing-pregnancy, and live-birth outcomes, and longitudinal autonomic, metabolic, inflammatory, ovarian, and endometrial measurements.
El-Shamy FF et al., 2018·Journal of lasers in medical sciences
Polycystic ovarian syndrome (PCOS) is one of the most widely recognized reasons for infertility. The aim of this study was to examine the impact of laser acupuncture on PCOS women. Twenty-five PCOS women were randomly allocated to either the study group (SG; n=13), treated by laser acupuncture, or the control group (CG; n = 12). Blood hormonal levels and insulin resistance were measured at baseline and after 12 weeks of intervention. The pre-intervention levels showed no statistically significant differences between SG and CG for baseline characteristics (P>0.05). After 12 weeks of intervention, within-group analyses showed that body mass index (BMI), blood hormonal levels, and insulin resistance were significantly decreased (P<0.05), while no significant changes in follicle-stimulating hormone (P>0.05) were recorded in the 2 groups. Between-groups analyses showed that most outcomes measures were significantly decreased (P<0.05) in SG compared with CG, with no significant changes in FSH and BMI (P>0.05). Laser acupuncture can be suggested as an effective management for PCOS women.
There is evidence of the beneficial effects of acupuncture in the treatment of polycystic ovary syndrome (PCOS). This study aimed to compare acupuncture with clomiphene in ovulation induction among infertile women with PCOS. This randomized clinical trial was conducted on infertile women with PCOS who were referred to the gynecology clinic of Imam Reza Hospital and Milad Infertility Center, Mashhad, Iran, from December 2015 to July 2016. Patients were randomly assigned to two groups; the intervention group (38 patients) received true acupuncture plus placebo clomiphene, whereas the control group (39 patients) received clomiphene plus sham acupuncture. Patients were compared in terms of folliculare growth, evidence of ovulation, and side effects of treatment. There was no statistically significant difference between the two groups in terms of demographic characteristics and PCOS criteria. The ovulation rates were 31.5% and 41.6% in the intervention and control groups respectively, indicating no statistically significant difference(p = 0.36). Also, in terms of side effects, the statistical difference between the two groups was not significant, except for headache which was significantly more common in the intervention group (p = 0.001). The rate of folliculargrowth was significantly higher in the control group during the first and third cycles (p = 0.01), whereas no significant difference was observed in the second cycle (p = 0.93). Acupuncture can be as effective as clomiphene treatment in inducing ovulation in infertile women with PCOS. Moreover, considering the few side effects of acupuncture, its application can be considered a safe option. IRCT201512057265N3.
Xu Y et al., 2017·PloS one·Free full text on PubMed Central
Endometriosis is a multifactorial, oestrogen-dependent, inflammatory, gynaecological condition that can result in long-lasting visceral pelvic pain and infertility. Acupuncture could be an effective treatment for endometriosis and may relieve pain. Our aim in the present study was to determine the effectiveness of acupuncture as a treatment for endometriosis-related pain. In December 2016, six databases were searched for randomised controlled trials that determined the effectiveness of acupuncture in the treatment of endometriosis-related pain. Ultimately, 10 studies involving 589 patients were included. The main outcomes assessed were variation in pain level, variation in peripheral blood CA-125 level, and clinical effective rate. All analyses were performed using comprehensive meta-analysis statistical software. Of the 10 studies included, only one pilot study used a placebo control and assessed blinding; the rest used various controls (medications and herbs), which were impossible to blind. The sample sizes were small in all studies, ranging from 8 to 36 patients per arm. The mean difference (MD) in pain reduction (pre- minus post-interventional pain level-measured on a 0-10-point scale) between the acupuncture and control groups was 1.36 (95% confidence intervals [CI] = 1.01-1.72, P<0.0001). Acupuncture had a positive effect on peripheral blood CA-125 levels, as compared with the control groups (MD = 5.9, 95% CI = 1.56-10.25, P = 0.008). Similarly, the effect of acupuncture on clinical effective rate was positive, as compared with the control groups (odds ratio = 2.07; 95% CI = 1.24-3.44, P = 0.005). Few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature suggests that acupuncture reduces pain and serum CA-125 levels, regardless of the control intervention used. To confirm these findings, additional, blinded studies with proper controls and adequate sample sizes are needed.
Li H et al., 2026·International journal of women's health
Polycystic ovary syndrome (PCOS) is closely associated with chronic low-grade inflammation. Systemic immune-inflammation index (SII) based on complete blood cell count has shown superior discriminative value in a variety of diseases, but its role in PCOS is still unclear. This study aimed to investigate the association between SII and PCOS in women undergoing their first in vitro fertilization (IVF) treatment with a gonadotropin-releasing hormone (GnRH) antagonist protocol. A total of 334 women undergoing their first IVF treatment with a GnRH antagonist protocol from January 2019 to December 2025 were included in this study. They were divided into the PCOS group (n=160) and the non-PCOS group (n=174). Demographic and physical indicators, reproductive endocrine indicators, systemic inflammatory indicators, infertility situation, ovulation induction treatment parameters, and trigger day indicators were collected. Binary logistic regression was used to identify the independent associated factors of PCOS. The results of the multivariate analysis indicated that anti-Mullerian hormone (AMH) (OR=1.437, 95% CI: 1.222-1.690, P<0.001), basal follicle-stimulating hormone (FSH) (OR=0.718, 95% CI: 0.519-0.993, P=0.046), luteinising hormone (LH) (OR=1.293, 95% CI: 1.100-1.519, P=0.002), testosterone (T) (OR=14.533, 95% CI: 2.162-97.677, P=0.006), SII (OR=2.030, 95% CI: 1.079-3.819, P=0.028), and LH level on the trigger day (OR=1.284, 95% CI: 1.061-1.554, P=0.010) were independently associated with PCOS. Among patients undergoing their first IVF treatment, SII was independently associated with PCOS. This further supported the crucial role of chronic low-grade inflammation in the pathophysiology of PCOS. In the future, its efficacy needs to be verified through large-scale studies. Before it is fully confirmed, it is not recommended to use it as an independent clinical tool.
ShengJun Chen, Zhu Xue, WeiWei Song
S Chen, Z Xue, W Song
PMID 42504173 42504173 DOI 10.2147/IJWH.S614225 10.2147/IJWH.S614225 Chen et al. 2026, Chen 2026