Systematic review of acupuncture to improve ovarian function in women with poor ovarian response

Poor ovarian response is a condition that affects a significant proportion of women seeking in vitro fertilization treatment, representing one of the main challenges in modern reproductive medicine. This condition is characterized by inadequate ovarian response to hormonal stimulation during assisted reproduction procedures, resulting in fewer oocytes retrieved, lower pregnancy rates, and a greater need for cycle cancellation. With increasing maternal age in contemporary society, the prevalence of this condition has grown, reaching between 9% and 24% of women undergoing controlled ovarian stimulation. For these patients, clinical pregnancy rates are significantly reduced, ranging from only 2% to 18%, compared with rates of 33% to 40% observed in women with normal ovarian response.

Faced with these challenges, researchers have sought complementary therapies that can improve the results of conventional treatments, and acupuncture emerges as a promising alternative due to its regulatory properties on the reproductive hormonal system.

This study consisted of a systematic review with meta-analysis aimed at scientifically evaluating the efficacy of acupuncture in treating women with poor ovarian response undergoing in vitro fertilization. The researchers conducted a comprehensive search across multiple scientific databases, including both Chinese and international literature, covering publications from inception through January 2023. Only randomized controlled clinical trials comparing the use of acupuncture combined with conventional hormonal therapy versus hormonal therapy alone were included. In total, seven studies were selected for analysis, involving 516 women diagnosed with poor ovarian response.

The studies analyzed used different acupuncture techniques, including traditional manual acupuncture, electroacupuncture, and transcutaneous electrical acupoint stimulation. The methodological quality of the studies was assessed using internationally standardized tools, and the results were statistically analyzed to identify consistent patterns of benefit.

The results of the analysis revealed important findings on the effects of acupuncture on various aspects of ovarian and reproductive function. Although acupuncture did not demonstrate a significant improvement in clinical pregnancy rates compared with conventional treatment alone, substantial benefits were identified in other parameters fundamental to the success of in vitro fertilization treatment. Acupuncture proved effective in significantly increasing the number of oocytes retrieved during procedures, a crucial factor for treatment success since more available oocytes increase the chances of successful fertilization. Additionally, acupuncture treatment resulted in improvement in embryo implantation rate and an increase in endometrial thickness, better preparing the uterine environment for implantation.

Regarding hormonal markers, acupuncture demonstrated the ability to reduce levels of follicle-stimulating hormone, an important indicator of ovarian function, and to increase estradiol levels, a hormone essential for follicular development. The study also showed improvement in the antral follicle count, a direct marker of patients' ovarian reserve.

From a clinical standpoint, these results suggest that acupuncture may be a valuable complementary therapy for women with poor ovarian response, especially when integrated into conventional ovarian stimulation protocols. For patients, this means a possible improvement in the quality of in vitro fertilization cycles, even if immediate pregnancy rates are not drastically altered. The improvement in ovarian and hormonal parameters may contribute to more efficient treatment cycles, potentially reducing the need for multiple attempts and decreasing the physical and emotional stress associated with fertility treatments. For healthcare professionals, the findings indicate that acupuncture may be recommended as a safe and beneficial intervention, especially considering that no significant adverse effects were reported in the studies analyzed.

Acupuncture may be particularly useful for patients with markers of diminished ovarian reserve or with a history of inadequate response to conventional ovarian stimulation treatments.

It is important to acknowledge the limitations of this study for adequate interpretation of the results. The methodological quality of the included studies was rated as low or very low, mainly due to the inability to apply adequate blinding techniques inherent to the nature of acupuncture treatments. Furthermore, there was considerable variability among studies regarding acupuncture techniques used, application points, and duration and frequency of treatments, which may have influenced the consistency of results. The limited number of available studies and relatively small sample sizes also restrict the generalizability of the findings.

Another aspect to consider is heterogeneity in the diagnostic criteria used to define poor ovarian response, since different studies applied distinct criteria, which may have contributed to the variability of results. Despite these limitations, the research provides encouraging evidence on the potential of acupuncture as a complementary therapy, indicating the need for future studies with greater methodological rigor, larger samples, and more standardized acupuncture protocols to confirm and expand these promising findings in reproductive medicine.