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

Diminished ovarian reserve is a condition that currently affects more than 26% of young women, characterized by reduced oocyte quality and decreased fertility. This situation can be caused by several factors, including advanced age, surgeries, chemotherapy, and lifestyle habits such as excessive alcohol consumption and smoking. Diagnosis is generally made through analysis of follicle-stimulating hormone (FSH) levels, anti-Müllerian hormone (AMH) levels, and the antral follicle count in the ovaries. Conventional treatments, although effective, can cause side effects such as ovarian hyperstimulation syndrome, venous thromboembolism, and even an increased risk of breast cancer.

Because of these limitations, many patients have sought complementary therapies such as acupuncture to improve their treatment outcomes.

This study aimed to evaluate the clinical efficacy of acupuncture in the treatment of diminished ovarian reserve through a systematic review and meta-analysis. The researchers conducted a comprehensive search across nine scientific databases, from inception through December 2022, looking for randomized controlled clinical studies investigating the effects of acupuncture on this condition. Inclusion criteria were rigorous, considering only studies involving patients diagnosed with diminished ovarian reserve through specific criteria, using manual acupuncture or electroacupuncture as the intervention. The main parameters analyzed were sex hormone levels and antral follicle count in the ovaries.

The methodological quality of the studies was carefully evaluated using standardized tools to identify possible biases in the results.

The analysis included 13 controlled clinical studies involving 787 patients, all conducted in China between 2015 and 2022. The results demonstrated that acupuncture produced significant benefits compared with control groups receiving traditional Chinese medications, hormonal therapy, or no treatment. Specifically, patients treated with acupuncture showed significant reduction in FSH levels, which when elevated indicate problems with ovarian function. There was also a decrease in the FSH/LH (luteinizing hormone) ratio, another important indicator of reproductive health.

In addition, an increase in anti-Müllerian hormone levels was observed, which directly reflects ovarian reserve, along with an elevation in antral follicle count, structures that contain developing oocytes. Subgroup analysis revealed that manual acupuncture proved superior to electroacupuncture in improving these parameters. The use of ten or more acupuncture points showed greater efficacy compared with fewer points, and combining acupuncture with Traditional Chinese Medicine also showed promising results.

For patients, these results suggest that acupuncture may be a valuable therapeutic option in the treatment of diminished ovarian reserve, offering an alternative or complement to conventional treatments. The improvement in hormonal markers and follicle count indicates that acupuncture may help partially restore ovarian function, which is especially important for women who wish to become pregnant. For healthcare professionals, these findings provide scientific evidence that can guide therapeutic decisions, suggesting that manual acupuncture with at least ten points, applied for approximately three months, may be recommended as part of a comprehensive treatment plan. Combination with traditional Chinese therapies also showed additional benefits, indicating that integrated approaches may be more effective than isolated treatments.

It is important to acknowledge the limitations of this study. All clinical trials were conducted in China, which may limit the applicability of results to other populations. Furthermore, there was high variability among the studies analyzed, including differences in types of acupuncture used, numbers of points applied, and combined therapies. Only one study assessed pregnancy outcomes, which would be a highly relevant outcome for these patients.

The methodological quality of some studies also presented limitations, with several not adequately describing how randomization of participants was performed. Despite these promising findings, the authors emphasize that higher-quality studies with larger samples and conducted in different regions of the world are needed to confirm these results. Patients interested in this therapy should always seek qualified professionals and discuss treatment options with their physicians, considering acupuncture as part of an integrated approach to their reproductive health care.