Clinical efficacy of acupuncture for diminished ovarian reserve: a systematic review and meta-analysis of randomized controlled trials

Electroacupuncture Improves Ovarian Function in Rats With Tripterygium Glycoside-Induced Diminished Ovarian Reserve by Promoting the Polarization of M2 Macrophages and Inhibiting Inflammatory Responses

Immunoinflammatory responses and macrophage polarisation are crucial for maintaining ovarian function. Moreover, electroacupuncture (EA) has been shown to protect ovarian function. However, the mechanisms by which EA improves ovarian function, including its effects on immunoinflammatory responses and macrophage polarisation, have not been determined. This study aimed to investigate the protective effects of EA on ovarian function in rats with diminished ovarian reserve (DOR) and to elucidate the regulatory mechanisms underlying inflammation and M1 and M2 macrophage polarisation. DOR models were established through the intragastric administration of 50 mg/kg Tripterygium glycoside suspension (TGs) for 14 consecutive days. The EA group received treatment at 2/100 Hz and 1.0 mA for 10 min using acupoints BL23, CV4 and CV12 for 14 days. Following the intervention, we employed various methodologies, including haematoxylin-eosin (H&E) staining, enzyme-linked immunosorbent assay (ELISA), flow cytometry, immunohistochemical (IHC) staining, western blotting and quantitative reverse transcriptase-polymerase chain reaction (PCR), to assess ovarian function, inflammatory factors and the expression levels of M1 and M2 macrophage-related factors. EA intervention reduced the oestrous cycle disorder rate in the rats compared with that in the DOR group, leading to an increase in growing follicles, a reduction in atretic follicles (AFs) and an enhancement of both the capillary (Cap) network and corpus luteum (CL) structure. This intervention also resulted in decreased serum levels of follicle-stimulating hormone (FSH), interferon-γ (IFN-γ) and tumour necrosis factor-α (TNF-α), along with increased levels of oestradiol (E2), interleukin-4 (IL-4) and interleukin-10 (IL-10). Furthermore, the number of M2 macrophages in the spleen increased, which was accompanied by elevated arginase 1 (Arg1) and decreased inducible nitric oxide synthase (iNOS) expression in the ovarian tissues. In summary, EA can restore the impaired ovarian function caused by TGs by promoting M2 macrophage polarisation and inhibiting inflammatory responses.

Clinical efficacy and pharmacological mechanism of Er Zhi Tian Gui formula in enhancing IVF-ET outcomes for diminished ovarian reserve

Objective

To investigate the efficacy of the Er Zhi Tian Gui Formula (EZTGF) in diminished ovarian reserve (DOR) patients undergoing in vitro fertilization-embryo transfer (IVF-ET); to examine the pharmacological mechanism of EZTGF in inhibiting ovarian granulosa cell (OGC) apoptosis.

Methods

A total of 120 DOR patients undergoing IVF-ET in the Affiliated Hospital of Shandong University of TCM from March to December 2021 were randomly assigned to the EZTGF (n = 60) or Placebo (n = 60) groups. All participants followed a gonadotropin-releasing hormone antagonist protocol for controlled ovarian stimulation, with interventions starting on days 2-3 of the preceding menstrual cycle and continuing until the trigger day. IVF-ET outcomes measured included the number of oocytes retrieved, embryo quality, and pregnancy rates. NEAT1, miR-10b-3p, and FOXO3a OGCs expression was analyzed via qRT-PCR. Mechanistic studies were conducted using KGN cells, with dual-luciferase reporter assays confirming regulatory relationship between NEAT1, miR-10b-3p, and FOXO3a.

Results

A total of 116 patients completed the trial (58 in each group). The EZTGF group showed a significant increase in both the number (especially at the cleavage stage) and rate of high-quality embryos, compared with the Placebo group (P < 0.05). No statistically significant differences in pregnancy outcomes were observed (P > 0.05). Cellular experiments showed that miR-10b-3p inhibits proliferation and promotes apoptosis in oocyte granulosa cells (OGCs). Dual luciferase reporter gene assay confirms target-regulatory relationship of NEAT1 with miR-10b-3p, miR-10b-3p and FOXO3a. EZTGF treatment partially reversed the low expression of NEAT1 and FOXO3a, and the high expression of miR-10b-3p in OGCs from DOR patients.

Conclusion

Treatment with EZTGF enhances embryo quality in women with DOR undergoing IVF-ET, which can be partially attributed to modulation of the NEAT1/miR-10b-3p/FOXO3a pathway. Trial registration: ChiCTR2100052522.

Acupuncture and related therapies for anxiety and depression in patients with premature ovarian insufficiency and diminished ovarian reserve: a systematic review and meta-analysis

Background

The decreased ovarian function has a negative impact on the mental health of women and increases the risk of anxiety and depression. A growing number of clinical studies have demonstrated that acupuncture-related therapies can effectively and safely restore hormone levels and improve ovarian reserve function. However, the effectiveness of acupuncture-related therapies in alleviating anxiety and depression symptoms in patients with ovarian hypofunction has not been thoroughly evaluated. Therefore, this study conducted a systematic review and meta-analysis to assess the impact of the different acupuncture-related therapies on the mental health of patients with ovarian hypofunction.

Methods

We comprehensively searched eight famous databases for randomized controlled trials up to October 30, 2024. Databases include PubMed, Web of Science, EMBASE and Cochrane Library, China Biomedical (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database and VIP Database.

Results

The study included 12 RCTs, involving 780 patients with ovarian hypofunction, including 403 patients with POI, 297 patients with DOR, and 80 patients with POF. Acupuncture-related therapy was obviously superior to hormone therapy in relieving anxiety symptoms (SMD: -0.90; 95%CI: -1.28, -0.53; P<0.000 01) and depressive symptoms (SMD: -0.82; 95% CI: -1.25, -0.40; P=0.0001).

Conclusions

Acupuncture-related therapy was more effective than hormone therapy in improving anxiety and depression symptoms in patients with ovarian hypofunction. This study supports the use of acupuncture-related therapies for women experiencing decreased ovarian function associated with mental health issues.

Systematic review registration

https://www.crd.york.ac.uk/, identifier CRD42023488015.

Efficacy of acupuncture for pregnancy with early-onset ovarian hyperstimulation syndrome: study protocol for a randomised controlled clinical trial

INTRODUCTION

Although ovarian hyperstimulation syndrome (OHSS) is a common complication primarily seen in patients undergoing in vitro fertilisation-embryo transfer, there is no recognised effective treatment to manage it, especially for pregnant patients. As an alternative non-pharmacological treatment, acupuncture presents itself as a promising, safe and effective intervention for those suffering from OHSS. Despite its potential, there is a noticeable absence of randomised controlled trials providing solid evidence on the efficacy of acupuncture in the management of pregnancy with OHSS. Therefore, the primary objective of this study is to conduct an initial investigation into the efficacy of acupuncture in pregnant patients with OHSS, hoping to contribute valuable insights from a medical-scientific perspective.

METHODS AND ANALYSIS

This is a three-arm, single-blind, parallel-design, randomised controlled clinical trial. A total of 384 patients will be enrolled and randomised in a ratio of 1:1:1 into acupuncture group (MA group), sham acupuncture group (SA group) and control group (C group) for a 20-day treatment period. The primary outcomes include 24-hour urine output, amount of ascites shown on ultrasound, abdominal circumference, degree of abdominal distension and chest tightness. The secondary outcomes are weight, ovarian size, rate of ascites drainage by tube placement and serum hCG. Besides, the study will consider changes in blood counts and hormonal levels as additional outcomes.

ETHICS AND DISSEMINATION

This study received authorisation from the Institutional Review Board of the Sixth Affiliated Hospital of Sun Yat-sen University on 4 February 2024 (Approval No. 2024ZSLYFEC-084). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry ChiCTR2400081751.

Conception vessel acupuncture research regularity in the treatment of diminished ovarian reserve: a multi-center, large-sample prospective cohort study protocol

Background

Diminished ovarian reserve (DOR) refers to a decrease in the number or quality of oocytes in the ovarian cortex, which is a degenerative disease of the reproductive system, and can further develop into premature ovarian failure. There are few studies on acupuncture and moxibustion for DOR, which are still in the exploratory stage.

Methods/design

This study was a real-world case registry study. According to whether the subjects received conception vessel acupuncture or not, they were divided into the basic treatment combined with conception vessel acupuncture group and the basic treatment group. A total of 1221 patients with DOR were enrolled and treated for 12 weeks. The percentage of patients with ≥30% improvement in anti-Müllerian hormone (AMH) was evaluated at the end of week 12. Secondary outcomes included Antral follicle count (AFC), modified Kupperman scale, basal FSH level, LH level, FSH/LH ratio, positive pregnancy, clinical pregnancy, early spontaneous abortion, ongoing pregnancy, and ectopic pregnancy.

Discussion

This study provides clinical evidence and theoretical support for the treatment of DOR with conception vessel acupuncture and moxibustion, so as to guide and improve the efficacy of acupuncture and moxibustion.

Trial registration

Acupuncture-Moxibustion Clinical Trial Registry ChiCTR2400080471. Registered on 30 January 2024.

The clinical value of acupuncture for women with premature ovarian insufficiency: a systematic review and meta-analysis of randomized controlled trials

Objective

The aim of this study was to evaluate the therapeutic implications of acupuncture on improving ovarian function in women diagnosed with premature ovarian insufficiency (POI) through the implementation of randomized clinical trials (RCTs).

Methods

A comprehensive search of eight databases was conducted to identify RCTs up until 5 October 2023. The outcomes included the levels of sex hormones, antral follicle count (AFC), Kupperman score, and total effective rate. The risk of bias (RoB) tool was utilized to evaluate the quality of the included studies. In order to guarantee the robustness and reliability of the findings, subgroup and sensitivity analyses were performed to investigate potential sources of heterogeneity.

Results

A total of 13 RCTs comprising 775 patients were included in the study. Acupuncture demonstrated significant efficacy in reducing follicle-stimulating hormone (FSH) [SMD = 0.83, 95% CI (0.27, 1.39), I 2 = 92%, p = 0.004], enhancing estradiol levels (E2) [SMD = 0.50, 95% CI (0.07, 0.93), p = 0.02, I 2 = 87%], and increasing anti-Müllerian hormone (AMH) [SMD = 0.24, 95% CI (0.05, 0.44), p = 0.01, I 2 = 8%], as well as improving the overall effective rate [RR = 1.22, 95% CI (1.10, 1.35), p < 0.01, I 2 = 14%]. Subgroup analysis revealed that compared with non-acupuncture therapy, the acupuncture with Chinese herbal medicine (CHM) and hormone replacement therapy (HRT) group exhibited a substantial reduction in FSH levels [SMD = 1.02, 95% CI (0.52, 1.51), I 2 = 60%, p < 0.01]. Furthermore, the acupuncture with CHM group also exhibited a substantial reduction [SMD = 4.59, 95% CI (1.53, 7.65), I 2 = 98%, p < 0.01]. However, only the acupuncture with CHM and HRT group demonstrated a significant increase in E2 levels [SMD = 0.55, 95% CI (0.23, 0.87), I 2 = 12%, p < 0.01].

Conclusion

Acupuncture has demonstrated superiority over non-acupuncture in diminishing serum FSH levels and increasing serum E2, AMH, and the overall efficacy rate in women diagnosed with POI. These research findings suggest the necessity for broader-scale research with meticulous designs to fully demonstrate the efficacy and safety of acupuncture in the treatment of women with POI.

Systematic review registration

https://www.crd.york.ac.uk, identifier CRD42023467751.

The effect of ovarian injection of autologous platelet rich plasma in patients with poor ovarian responder: a systematic review and meta-analysis

Objective

To evaluate the effects of ovarian injection of autologous platelet rich plasma (aPRP) on patients with poor ovarian responder (POR) based on the existing clinical evidence.

Methods

According to systematic review and meta-analysis, we comprehensively searched nine databases established as of September 6, 2023, and evaluated the impact of ovarian PRP infusion on poor ovarian responder. The research results include serum follicle-stimulating hormone(FSH) and anti-Mullerian hormone(AMH) levels, antral Follicle Count(AFC), oocyte number, and embryo number. The Newcastle Ottawa Scale (NOS) was used to evaluate the quality of inclusion in trials.

Results

Add up to 10 studies consisting of 793 participants were included in the meta-analysis. A review of existing evidence showed that intraovarian injection of PRP has significant therapeutic effects in increasing levels of anti-Müllerian hormone (AMH) (SMD=0.44,95% CI [0.07,0.81], p=0.02), antral follicle count (AFC) (MD=1.15,95% CI [0.4,1.90], p=0.003), oocyte count (MD=0.91, 95% CI [0.40, 1.41], p=0.0004), and embryo number (MD=0.78, 95% CI [0.5,1.07], p<0.0001). We compared the relevant data of patients before and after treatment after 2 months of intervention. It can be seen that ovarian injection of PRP treatment for 2 months has better effects in reducing FSH levels, increasing AMH levels, increasing antral follicle count, and increasing the number of oocytes and embryos (p<0.05). When the dose of PRP injected into each ovary was ≥ 4ml, there was also a significant correlation (p<0.05) with improving the number of AFC, oocytes and embryos. Significant heterogeneity existed among the studies.

Conclusion

The pooled results suggest that intra-ovarian injection of PRP can promote ovarian regeneration and improve the reproductive outcomes of patients with ovarian dysfunction. This therapy may have significant clinical potential in improving sex hormone levels, increasing AFC, oocyte count, and embryo count. However, this findings still requires more rigorous and extensive trials worldwide to determine the value of intra-ovarian injection of PRP in POR patients.

Systematic review registration

https://www.crd.york.ac.uk, Identifier CRD42023451232.