Efficacy and safety of acupuncture-related therapies in improving insulin resistance, reproductive endocrine outcomes, and ovarian morphology in polycystic ovary syndrome: a systematic review and network meta-analysis
Abstract
Objective: This network meta-analysis aimed to compare and rank the efficacy and safety of acupuncture-related therapies (ARTs) for polycystic ovary syndrome (PCOS) in improving insulin resistance (IR), reproductive endocrine outcomes, and ovarian morphology.
Methods: Randomized controlled trials (RCTs) in Chinese and English were retrieved up to September 2025 from eight databases (the Cochrane Library, Web of Science, PubMed, Embase, VIP, CNKI, Wanfang, and CBM). Eligible participants were women with PCOS diagnosed using established international or Chinese criteria. Interventions compared ARTs (e.g., acupuncture, moxibustion, electroacupuncture) versus conventional medication and/or placebo. The primary outcome was homeostatic model assessment of IR (HOMA-IR). Secondary outcomes included fasting insulin (FINS), fasting blood glucose (FBG), body mass index (BMI), waist-to-hip ratio (WHR), testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), LH/FSH, antral follicle count (AFC), and ovarian volume (OV). Risk of bias was assessed using Review Manager 5.3, and network meta-analysis with surface under the cumulative ranking curve (SUCRA) rankings was conducted in Stata 17.0. All outcomes were summarized as mean differences (MDs) with 95% confidence intervals (CIs).
Results: 53 RCTs involving 4,406 participants and 12 ART regimens (including two combined regimens) were included. Acupoint injection therapy (AIT) and acupuncture plus moxibustion (Acu +…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,406 participants or records.
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