Polycystic Ovary Syndrome: Effect and Mechanisms of Acupuncture for Ovulation Induction. Review Article
Julia Johansson1 and Elisabet Stener-Victorin2. Evidence-Based Complementary and Alternative Medicine Volume 2013 (2013)
1Institute of Neuroscience and Physiology, Department of Physiology, Sahlgrenska Academy, University of Gothenburg, Box 434, 405 30 Gothenburg, Sweden
2Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China
Abstract. Polycystic ovary syndrome (PCOS), the most common endocrine disorder among women of reproductive age, is characterized by the coexistence of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries (PCO). PCOS also represents the largest part of female oligoovulatory infertility, and the management of ovulatory and menstrual dysfunction, comprises a third of the high costs of PCOS treatment. Current pharmacological and surgical treatments for reproductive symptoms are effective, however, associated with negative side effects, such as cardiovascular complications and multiple pregnancies. For menstrual irregularities and ovulation induction in women with PCOS, acupuncture has indicated beneficial effects. This review will focus on the results from randomized controlled acupuncture trials for regulation of menstrual dysfunction and for inducing ovulation in women with PCOS although there are uncontrolled trials with nonetheless interesting results. Animal experimental studies will be further discussed when they can provide a more mechanistic explanatory view.
The viscous circle of PCOS features aggravating each other may be driven by androgens, insulin, or other factors but must be broken to improve the health status of women with PCOS. Although pharmacological treatment may be effective, they are also associated with negative side-effects. This review addresses acupuncture as a potential treatment option for reproductive and endocrine disturbances in women with PCOS. Several clinical and animal experimental studies indicate that acupuncture is beneficial for ovulatory dysfunction in PCOS. This is also related to decreased levels of sex steroids and possibly inhibin B. Although the clinical data does not support changes in LH pulsatility/secretion pattern as a possible mediator for this effect, there is strong evidence of central components that probably involve both opioid and sympathetic activities, an effect that may be mediated via the androgen receptor. However, the causality of changes in ovulation and sex steroids is difficult to determine. The reduction of androgen levels by normalization of intrinsic ovarian aberrations may calm the exaggerated follicular growth, restore the follicle maturation processes, and hence lead to ovulation. It could also be the other way around that improved ovulation, possibly caused by external factors, restoring follicular growth and/or aberrations and thereby reducing androgen levels due to the lower pool and/or activity of androgen producing cells.
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Progress of integrative Chinese and Western medicine in treating polycystic ovarian syndrome caused infertility.
Song JJ, Yan ME, Wu XK, Hou LH. Chin J Integr Med. 2006 Dec;12(4):312-6.
Gynecological and Obstetric Department, First Hospital, Heilongjiang University of Traditional Chinese Medicine, Harbin (150040). PMID: 17361532 [PubMed - indexed for MEDLINE]
Abstract Polycystic ovarian syndrome (PCOS) is one of the most popular diseases that cause menstrual dysfunction and infertility in women. The present paper is a brief retrospection on the progress in treatment of PCOS caused infertility with integrative Chinese and Western medicine (ICWM). It can be seen from these materials that using traditional Chinese medicine (TCM) recipes formulated by Shen-replenishing herbs or acupuncture to reinforce Gan-Shen, regulate Chong-Ren Channels in treating PCOS, stable clinical efficacy could be obtained, with less adverse reaction, though the effect initiated somewhat late. Whereas, when Shen-replenishing recipe and acupuncture are combined with hormone or ovulation promoting drugs of Western medicine, the above-mentioned shortcomings would be overcome. So, this combined therapy is frequently used in clinical practice.
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Clinical studies on the mechanism for acupuncture stimulation of ovulation
Mo X; Li D; Pu Y; Xi G; Le X; Fu Z Zhejiang College of Traditional Chinese Medicine, Hangzhou. Quoted in JCM 78 june 2005
Ovulatory dysfunction is commonly seen in gynecology clinic. It may cause infertility, functional uterine bleeding and a variety of complications. This research according to Traditional Chinese Medicine theory records treating with acupuncture 34 patients suffering from ovulatory dysfunction.
Treated on an average of 30 times, the patients' symptoms improved to varying degrees. The marked effective rate was 35.29%, the total effective rate being 82.35%. The results also showed that acupuncture may adjust FSH, LH, and E2 in two directions and raise the progesterone level, bringing them to normal. The animal experiments confirmed this result.
Results showed that acupuncture may adjust endocrine function of the generative and physiologic axis of women, thus stimulating ovulation. The results of this research will provide some scientific basis for treating and further studying this disorder.
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Acupuncture Normalizes Dysfunction of Hypothalamic-Pituitary-Ovarian Axis
Bo-Ying Chen M.D., professor of Neurology, Institute of Acupuncture and Department of Neurobiology, Shanghai Medical University, Shanghai 200032, P.R. China, Quoted in JCM 78 june 2005
This article summarizes the studies of the mechanism of electro acupuncture (EA) in the regulation of the abnormal function of hypothalamic pituitary-ovarian axis (HPOA) in our laboratory. Clinical observation showed that EA with the effective acupoints could cure some anovulatory patients in a highly effective rate and the experimental results suggested that EA might regulate the dysfunction of HPOA in several ways, which means EA could influence some gene expression of brain, thereby, normalizing secretion of some hormones, such as GnRH, LH and E2. The effects of EA might possess a relative specificity on acupoints.