Effectiveness of Acupuncture for Infertility in Patients with Polycystic Ovary Syndrome: A Systematic Review and Network Meta-Analysis

Wu Y, Xiao QW, Wang SD, Xu HF, Fang YG · Endocrine, Metabolic & Immune Disorders - Drug Targets · 2026 April 24

DOI 10.2174/0118715303297819240826065755

Objective

To investigate the clinical effectiveness of acupuncture in patients with polycystic ovary syndrome (PCOS) experiencing infertility using network meta-analysis method.

Conclusions

Acupuncture as a complementary treatment to clomiphene citrate (CC) and letrozole (LE) was found to improve reproductive hormone levels and enhance pregnancy success rates in PCOS infertility patients, with the highest probability of achieving the best pregnancy outcomes associated with CC plus warm acupuncture (WA) and LE plus manual acupuncture (MA) treatments.

Critical Appraisal

Does adding acupuncture to medication improve pregnancy or live-birth outcomes in women with PCOS?

The authors report higher pregnancy odds when acupuncture was added to clomiphene or letrozole, but unresolved reporting and analysis discrepancies limit confidence in this finding. Nine trials contributed pregnancy data for 1,198 participants, with a reported pooled odds ratio of 1.82 (95% confidence interval 1.43–2.33). This does not mean an 82% increase in the probability of pregnancy. Treatment courses lasted three to six months, but pregnancy definitions and assessment timing were insufficiently specified. The review does not establish improved live-birth outcomes, adequately characterise safety, or show that acupuncture can replace fertility medication.

What limits confidence in this review’s reported increase in pregnancy?

The included evidence and the review’s internal inconsistencies both warrant caution. The authors describe the trials as generally low quality and acknowledge possible publication bias, so favourable findings may be overrepresented. Separately, the pregnancy analysis is described as using a random-effects model, whereas its forest plot labels the calculation as fixed-effect; these approaches can produce different estimates and uncertainty intervals. Participant totals also conflict: the text gives 735 acupuncture-group participants, while Table 2 sums to 765. These are confirmed reporting inconsistencies, not proof that every result is wrong, but the original trial data and analysis files are needed to resolve them.

Does the review establish which acupuncture–medication combination gives the best pregnancy outcomes?

No. Warm acupuncture with clomiphene and manual acupuncture with letrozole received the highest estimated ranking probabilities within their respective medication groups, but the review found no statistically significant differences between acupuncture approaches within either group. Ranking probabilities describe how treatments rank under the statistical model; they are not patients’ chances of becoming pregnant and do not establish superiority. The network also consists of two disconnected groups, with no evidence connecting the clomiphene combinations to the letrozole combinations. Consequently, it cannot identify a single best combination across both medicines, and the wide uncertainty intervals leave clinically important differences unresolved.

Assessed 18 Sept 2026.

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Insights

Acupuncture, combined with certain medications, improves hormone levels and enhances success rates of pregnancy in patients suffering from polycystic ovary syndrome infertility.

The research identifies trials about the effectiveness of acupuncture in combination with medications, namely clomiphene citrate and letrozole, for patients with polycystic ovary syndrome experiencing infertility. The study accesses various scientific databases, selecting randomized controlled trials to extract data for the network meta-analysis. Using the R software gemtc package, the researchers compile a closer examination, setting medication-only treated patients as controls, and identifying the impact of different types of acupuncture treatments - manual, electro, and warm - when amalgamated with the medications. The results indicate that the combined therapy of acupuncture and medication significantly reduces the serum levels of luteinizing hormone and increases testosterone concentrations in patients as compared to medication-only treatment. Enhanced estradiol levels were also noticed when clomiphene citrate was paired with acupuncture, as opposed to its singular use. The marriage of acupuncture with medication demonstrated a significantly high success rate of pregnancy, specifically noted in the use of clomiphene citrate with warm acupuncture and letrozole with manual acupuncture, leading to the best pregnancy outcomes.