Electroacupuncture modulates reproductive hormone levels in patients with primary ovarian insufficiency: results from a prospective observational study

Immediate and Long-Term Effects of Tibial Nerve Stimulation on the Sexual Behavior of Female Rats

OBJECTIVES

There are limited treatment options for female sexual dysfunction (FSD). Percutaneous tibial nerve stimulation (PTNS) has shown improvements in FSD symptoms in neuromodulation clinical studies, but the direct effects on sexual function are not understood. This study evaluated the immediate and long-term effects of PTNS on sexual motivation and receptivity in a rat model of menopausal women. Our primary hypothesis was that long-term PTNS would yield greater changes in sexual behavior than short-term stimulation.

MATERIALS AND METHODS

In two experiments, after receiving treatment, we placed ovariectomized female rats in an operant chamber in which the female controls access to a male by nose poking. We used five treatment conditions, which were with or without PTNS and no, partial, or full hormone priming. In experiment 1, we rotated rats through each condition twice with behavioral testing immediately following treatment for ten weeks. In experiment 2, we committed rats to one condition for six weeks and tracked sexual behavior over time. We quantified sexual motivation and sexual receptivity with standard measures.

RESULTS

No primary comparisons were significant in this study. In experiment 1, we observed increased sexual motivation but not receptivity immediately following PTNS with partial hormone priming, as compared with priming without PTNS (linear mixed effect models; initial latency [p = 0.34], inter-interval latency [p = 0.77], nose poke frequency [p = 0.084]; eight rats). In experiment 2, we observed trends of increased sexual receptivity (linear correlation for weekly group means; mounts [p = 0.094 for trendline], intromissions [p = 0.073], lordosis quotient [p = 0.58], percent time spent with a male [p = 0.39], decreased percent time alone [p = 0.024]; four rats per condition), and some sexual motivation metrics (linear correlation for weekly group means; nose pokes per interval [p = 0.050], nose poke frequency [p = 0.039], decreased initial latency [p = 0.11]; four rats per condition) when PTNS was applied long-term with partial hormone priming, as compared with hormone-primed rats without stimulation.

CONCLUSIONS

PTNS combined with hormone priming shows potential for increasing sexual motivation in the short-term and sexual receptivity in the long-term in rats. Further studies are needed to examine variability in rat behavior and to investigate PTNS as a treatment for FSD in menopausal women.

Efficiency and safety of acupuncture for women with premature ovarian insufficiency: study protocol for a randomized controlled trial

Acupuncture has been widely used as an alternative and complementary therapy for premature ovarian insufficiency (POI) in China. However, research to date has not shown that acupuncture is effective for POI compared with hormone replacement therapy (HRT). We will conduct a randomized, controlled, and outcome assessor-blind trial to evaluate the efficacy and safety of acupuncture on POI. Seventy-six patients with POI will be randomly assigned to two groups. The treatment group will receive twenty-eight one-hour sessions of acupuncture treatments, and the control group will receive 12-week HRT. The whole study will consist of a 12-week treatment plan and a 12-week follow-up session. The primary outcome is measured by changes in serum anti-Müllerian hormone and follicle-stimulating hormone (FSH) levels at weeks 12 and 24. Secondary outcome measures include estradiol, luteinizing hormone (LH), LH/FSH ratio, Kupperman index, and menstrual condition. This trial is expected to clarify whether or not acupuncture is effective and safe for POI compared with HRT.

Complementary and Alternative Medicine for Premature Ovarian Insufficiency: A Review of Utilization and Mechanisms

Premature ovarian insufficiency (POI) is defined as a decline in ovarian function before the age of 40 and is one of the leading causes of infertility in women. The etiology is complex, and the pathogenesis is not clear. The main treatment is hormone replacement therapy, but a growing body of data confirms that such treatment can increase the risk of endometrial disease and cardiovascular disease. Complementary and alternative medicine (CAM) has been widely used in patients with POI due to its limited adverse reactions and high efficiency. According to literature reports, CAM therapy for POI mainly includes traditional Chinese medicine, acupuncture, psychotherapy, dietary supplements, and exercise therapy. This article reviews the application of CAM in the treatment of POI and attempts to determine the therapeutic effects and the mechanisms behind these effects based on existing clinical and experimental studies in order to provide theoretical support for the treatment of POI.

Effect of acupuncture for diminished ovarian reserve: study protocol for a randomized controlled trial

Background

Diminished ovarian reserve (DOR) is a condition in which the ovary loses its normal reproductive potential, compromising fertility. Although the prevalence and incidence of DOR is increasing, there are currently no effective treatments for this condition. Acupuncture has been reported as an alternative therapy for female infertility. The purpose of this study is to investigate the effect of acupuncture for women with DOR.

Methods/design

In this randomized controlled trial, a total of 120 women with DOR will be randomly assigned to receive either acupuncture or sham acupuncture for 12 weeks. The primary outcome will be determined by the mean change from baseline in the antral follicle count (AFC) at week 12. Secondary outcomes include serum levels of FSH, LH, E2, and AMH, the length of menstrual cycle, and the score of Self-Rating Anxiety Scale (SAS).

Discussion

This study is expected to investigate the effectiveness of acupuncture versus sham acupuncture in improving ovarian reserve for women with DOR.

Trial registration

Acupuncture-Moxibustion Clinical Trial Registry ChiCTR1800014988. Registered on 6 February 2018

Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial

Acupuncture is believed to improve ovarian reserve and reproductive outcomes in women undergoing in vitro fertilization (IVF). This study was conducted to evaluate the effect of network-optimized acupuncture followed by IVF on the oocyte yield in women showing a poor ovarian response. This study was an exploratory randomized controlled trial conducted from June 2017 to January 2020 at the Pusan National University Hospital. Women diagnosed with poor ovarian response were enrolled and randomly divided into two groups: IVF alone and Ac + IVF groups (16 acupuncture sessions before IVF treatment). Eight acupoints with high degree centrality and betweenness centrality were selected using network analysis. Among the participants, compared with the IVF treatment alone, the acupuncture + IVF treatment significantly increased the number of retrieved mature oocytes in women aged more than 37 years and in those undergoing more than one controlled ovarian hyperstimulation cycle. The negative correlation between the number of retrieved mature oocytes and consecutive controlled ovarian hyperstimulation cycles was not observed in the Ac + IVF group irrespective of the maternal age. These findings suggest that physicians can consider acupuncture for the treatment of women with poor ovarian response and aged > 37 years or undergoing multiple IVF cycles.

Acupuncture Improving Early Sexual Development of Girls with Peripheral Precocious Puberty: A Prospective Cohort Study

OBJECTIVE

To study primarily on the effect of acupuncture on breast Tanner stage, serum sex hormone level, and TCM symptom scores in girls with peripheral precocious puberty (PPP).

METHODS

19 eligible patients diagnosed with PPP received acupuncture intervention for 12 weeks, twice a week for 12 weeks, 24 sessions of acupuncture treatment in all, and then follow-up for 12 weeks. The primary outcome was the change in serum luteinizing hormone (LH) level, follicle-stimulating hormone (FSH) level, and breast Tanner stage at 12-week treatment and 12-week follow-up. Serum estradiol (E2) level and TCM symptom scores were also assessed.

RESULTS

Nineteen patients with peripheral precocious puberty were treated with acupuncture. After the 12-week acupuncture intervention, the serum LH level, breast Tanner stage, and TCM symptom scores decreased significantly compared with baseline (P < 0.05); the serum FSH and E2 level did not change significantly after the 12-week treatment (P > 0.05). After the 12-week follow-up, breast Tanner stage and TCM symptom scores decreased significantly compared with baseline (P < 0.05), and there was no statistical difference between serum sex hormone (LH, FSH, and E2) level and baseline level (P > 0.05). During the period of acupuncture treatment, no side effects or serious adverse events occurred.

CONCLUSIONS

Acupuncture is effective in regulating the hormone level and controlling early development process. It may be a viable alternative to the treatment of peripheral precocious puberty in girls. However, further randomized controlled trials are needed.

Acute and long-term effects of electroacupuncture alter frontal and insular cortex activity and functional connectivity during resting state

Electroacupuncture (EA) is a safe method for treating obesity; however, its underlying neural mechanisms remain unclear. We employed resting-state-functional-magnetic-resonance-imaging (RS-fMRI) and amplitude-of-low-frequency-fluctuation (ALFF) to investigate acute/long-term effects of EA on brain activity and resting-state-functional-connectivity (RSFC) in overweight/obesity subjects who received real/Sham stimulation. For acute effects, 26 and 19 overweight/obesity subjects were included in EA and Sham groups respectively. There were significant time effects on ALFF in the right insula (INS) and left dorsolateral-prefrontal-cortex (DLPFC) due to decreases/increases in INS/DLPFC in both groups. There were weaker positive RSFC between INS and supplementary-motor-area (SMA)/right DLPFC and weaker negative RSFC between INS and precuneus (PCUN); stronger negative RSFC between DLPFC and dorsomedial-prefrontal-cortex (DMPFC) in both groups. For long-term study, body-mass-index (BMI) had significant reduction in EA (n = 17) and Sham (15) groups; EA had higher BMI reduction than in Sham. There were significant time effects on ALFF in right ventrolateral-prefrontal-cortex (VLPFC) due to significant increases in EA group, and stronger positive RSFC between VLPFC and orbitofrontal-cortex and negative RSFC between VLPFC and left thalamus (THA) in both groups after long-term treatment. These findings suggest that changes in resting-activity and RSFC implicated in inhibitory-control, gastric-motility and satiety-control are associated with EA-induced weight-loss.

Health-related quality-of-life among patients with premature ovarian insufficiency: a systematic review and meta-analysis

PURPOSE

To systematically review studies investigating health-related quality-of-life (HrQoL) in patients with premature ovarian insufficiency (POI), to examine questionnaires used and to conduct a meta-analysis of control studies with normal ovarian function.

METHODS

Data sources: PubMed, Embase, Web of science, CNKI, and CQVIP, searched from inception until June 2018. The search strategy was a combination of medical (e.g. POI), subjective (e.g. well-being) and methodological (e.g. questionnaires) keywords. PRISMA guidelines were used to assess outcome data quality/validity by one reviewer, verified by a second reviewer. Risk of bias within studies was evaluated. A meta-analysis compared HrQoL in patients and non-patients. Due to measurement differences in the studies, the effect size was calculated as standard mean difference.

RESULTS

We identified 6869 HrQoL studies. Nineteen geographically diverse studies met inclusion criteria, dated from 2006, using 23 questionnaires. The meta-analysis included six studies with 645 POI participants (age 33.3 ± 5.47) and 492 normal-ovarian control subjects (age 32.87 ± 5.61). Medium effect sizes were found for lower overall HrQoL (pooled SMD = - 0.73, 95% CI - 0.94, - 0.51; I² = 54%) and physical function (pooled SMD = - 0.54, 95% CI - 0.69, - 0.39; I² = 55%). Heterogeneity was investigated. Effect sizes varied for sexual function depending on the measure (SMD = - 0.27 to - 0.74), overall HrQoL (SF-36) had the largest effect size (- 0.93) in one study. The effect sizes for psychological and social HrQoL were small.

CONCLUSION

POI is associated with low-to-medium effect size on HrQoL compared to normal ovarian controls. The greatest effects are found in general HrQoL and most sexual function areas. Condition-specific questionnaires and RCTs are recommended for further investigation.

Acupuncture for patients with premature ovarian insufficiency: A systematic review protocol

BACKGROUND

Premature ovarian insufficiency (POI) is a difficult-to-treat gynecological disorder with complex etiologies. Although acupuncture has gained increased popularity for the management of POI, evidence regarding its efficacy is lacking. This systematic review protocol aims to describe a meta-analysis to assess the effectiveness and safety of acupuncture for patients with POI.

METHODS

The following 10 databases will be searched from the publishment to July 2019: PubMed, Embase, the Web of Science, the Cochrane Central Register of Controlled Trials, 4 Chinese databases (China National Knowledge Infrastructure, Wanfang Digital Periodicals, Chinese Biomedical Literature Database, Chinese Scientific Journal Database database), 1 Korean medical database (KoreaMed), 1 Japanese medical database (National Institute of Informatics). The primary outcomes will be the resumption of menstruation and the serum FSH levels, and the secondary outcomes include the serum Estradiol levels, anti-Mullerian hormone levels, antral follicle count, follicular growth, endometrial thickness, and adverse events. We will use RevMan V.5.3 to conduct the meta-analysis, if possible. If it is not allowed, a descriptive analysis or a subgroup analysis will be conducted. Risk ratio for dichotomous data and mean differences or standardized mean differences for continuous data will be calculated with 95% confidence intervals using a random effects model or a fixed effects model.

RESULTS

This study will provide the latest analysis of the currently available evidence for the efficacy of acupuncture in treating POI.

PROSPERO REGISTRATION NUMBER

CRD42019125996.

A Literature Review of Women's Sex Hormone Changes by Acupuncture Treatment: Analysis of Human and Animal Studies

Background

It has been known that acupuncture treatment relieves gynecological disorders such as menopause, ovarian dysfunction, and dysmenorrhea. Sex hormones, including estrogen, progesterone, and gonadotropins, are related to the women disease. However, regulative effect of acupuncture on sex hormones has not been fully identified.

Methods

Acupuncture articles including analysis of sex hormones were searched in electronic databases from inception to June 2018. The methodological quality was assessed using modified CAMRADES tool. A total of 23 articles were selected and analyzed.

Results

In the results, overall studies showed that acupuncture increases estrogen, especially estradiol, progesterone, prolactin, and other hormones. Estradiol level was increased in most of studies except 3 studies which resulted in decreased level or not meaningful change. Two studies showed increase of FSH and LH whereas it was decreased in other studies. Other hormones were mostly increased by acupuncture.

Conclusion

This study possibly indicates that acupuncture changes sex hormone in various gynecological conditions in women.

Premature ovarian failure of autoimmune etiology in 46XX patients: is there a hope?

OBJECTIVES

To evaluate the efficacy of live bee stings at fertility points and acupuncture in treating symptoms and managing infertility in premature ovarian failure (POF) of autoimmune etiology.

PATIENTS AND METHODS

Patients with primary POF were allocated randomly into two groups: group I: subjected to acupuncture at specific fertility points and group II: subjected to live bee stings at sites of fertility points.

RESULTS

A total of 24 cases show significant reduction of Follicle stimulating hormone (FSH) level to normal range with gradual decline over the study duration: 13 cases in group I and 11 cases in group II. Eight cases got pregnant while the other 13 cases regained normal menses but still infertile.

CONCLUSIONS

Both bee sting therapy and acupuncture were effective in reduction of FSH levels with restoration of regular menstrual patterns and restoration of fertility. The bee sting therapy was superior in the pregnancy rate, while acupuncture was superior in alleviation of symptoms.

Electroacupuncture for reproductive hormone levels in patients with diminished ovarian reserve: a prospective observational study

Background

Effective methods for the treatment of reproductive dysfunction are limited. Previous studies have reported that acupuncture can modulate female hormone levels, improve menstrual disorders, alleviate depression and improve pregnancy rates. However, studies of acupuncture for diminished ovarian reserve (DOR) are lacking.

Objective

To carry out a prospective observational study aimed at assessing the effect of EA on the reproductive hormone levels of patients with DOR seeking fertility support and consider its safety.

Methods

Eligible patients with DOR received EA for 12 weeks: five times a week for 4 weeks followed by three times a week for 8 weeks. The primary outcome was the change in mean follicle-stimulating hormone (FSH) level at week 12. Mean luteinising hormone (LH) and serum oestradiol (E2) levels, FSH/LH ratios and symptom scale scores were simultaneously observed.

Results

Twenty-one patients with DOR were included in the final analysis. Mean FSH levels fell from 19.33±9.47 mIU/mL at baseline to 10.58±6.34 mIU/mL at week 12 and 11.25±6.68 mIU/mL at week 24. Change in mean FSH from baseline was −8.75±11.13 mIU/mL at week 12 (p=0.002) and −8.08±9.56 mIU/mL at week 24 (p=0.001). Mean E2 and LH levels, FSH/LH ratios and irritability scores were improved at weeks 12 and/or 24. Approximately 30% patients reported subjective increases in menstrual volume after treatment.

Conclusions

EA may modulate reproductive hormone levels and the effects seem to persist for at least 12 weeks after treatment with no significant side effects. EA may improve the ovarian reserve of patients with DOR, though further research is needed.

Trial registration number

NCT02229604; Results.

Effectiveness of Acupuncture for Primary Ovarian Insufficiency: A Systematic Review and Meta-Analysis

Objective. This systematic review aimed to assess current evidence from randomized controlled trials (RCTs) on the effects of acupuncture for patients with primary ovarian insufficiency (POI). Methods. We searched twelve databases to identify relevant studies published before July 2014. The outcomes were serum follicle-stimulating hormone (FSH) levels and resumption of menstruation. Two reviewers independently assessed the risk of bias using the Cochrane's tool, extracted the results, and evaluated the overall level of the evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results. Eight RCTs were selected. Acupuncture significantly lowered serum FSH levels and more women receiving acupuncture reported resumption of menses. However, the results should be interpreted with caution due to a small number of participants, high risk of bias for blinding, and likely publication bias. The level of evidence for FSH level and resumption of menses were assessed as “low” using GRADE. Conclusion. The current evidence on acupuncture for POI is insufficient to draw a firm conclusion due to scarcity of studies with a low risk of bias and likely publication bias. Further rigorously designed and conducted studies are needed to confirm the effectiveness and safety of acupuncture in patients with POI.

Effects of Electroacupuncture on Bone Mass and Cathepsin K Expression in Ovariectomised Rats

Objective

To characterise the effects of early and late electroacupuncture (EA) treatment on serum 17β-oestradiol (E2), C-terminal cross-linking telopeptide of type I collagen (CTX-I), bone mineral density (BMD), biomechanical bone strength and mRNA expression of cathepsin K in ovariectomised (OVX) rats.

Methods

Sixty Sprague-Dawley rats underwent ovariectomy (n=40) or sham surgery (n=20) and were randomly divided into two batches. Batch 1 (n=30) consisted of 10 sham-operated rats (Sham-0 group) and 20 OVX rats: half commenced EA immediately (early EA group, n=10) and half were left untreated (OVX-0 group, n=10). Batch 2 (n=30) consisted of 10 sham-operated rats (Sham-12 group) and 20 OVX rats: half commenced EA treatment 12 weeks after ovariectomy (late EA group, n=10) and half were left untreated (OVX-12 group, n=10). Rats in batches 1 and 2 were killed after 12 and 24 weeks, respectively. Serum E2, CTX-I, BMD, bone strength and cathepsin K expression were determined by ELISA, dual energy X-ray absorptiometry, biomechanical assessment and qRT-PCR, respectively.

Results

Both early and late EA treatment increased serum E2 levels, reduced serum CTX- I levels and increased BMD and bone strength of the L5 vertebral body in OVX rats. Although early EA treatment similarly increased BMD and bone strength of the femur, late EA treatment did not. However, both early and late EA treatment reduced mRNA expression of cathepsin K in OVX rats.

Conclusions

Early EA completely prevented and late EA partially prevented bone loss and deterioration of bone strength in OVX rats. The timing of initiation of EA treatment may be an important consideration for optimisation of effects. The influence of EA on bone strength appears to be at least partially mediated through regulation of the expression of cathepsin K.

Effect of acupuncture on premature ovarian failure: a pilot study

To investigate the effect of acupuncture on women with premature ovarian failure (POF), prospective consecutive case series study was applied. 31 women with POF were included; all patients were treated with acupuncture once every other day, three times a week for three months. Acupoints, GV 20, GV 24, GB 13, CV 3, CV 4, BL 23, BL 32, ST 25, ST 28, ST 29, ST 36, SP 6, KI 3, and LR 3, were selected. Serums FSH, E2, and LH level, Self-Rating Anxiety Scale (SAS), and Kupperman score were measured at baseline and at the end of treatment; the menstrual cycle was recorded during one-month follow-up. Compared with baseline, patients' serums FSH and LH were decreased, E2 was increased, and SAS score and Kupperman score were decreased. Four patients resumed menstrual cycle after treatment and two resumed during follow-up. No serious adverse events were found in all patients. The results indicate that acupuncture may decrease serums FSH and LH level, raise serum E2 level, relieve anxiety, reduce mental stress, and improve the menopausal symptoms.

Acupuncture stimulation and neuroendocrine regulation

Acupuncture has been used to treat different conditions for at least 3000 years in China and has gained increasing acceptance worldwide. The acupuncture needle inserted into the muscle layer at the acupoint produces the so-called obtaining qi sensation that causes the excitation of A-δ and C-fibers of the muscle tissue, resulting in afferent signals. The afferent signals pass through the dorsal horn cells of the spinal cord ascending to the brain, such as the hypothalamus, enhancing the release of neuropeptides and hormones, and these afferent signals in the spinal segment may innervate the visceral organ, inducing effect on visceral function. Here, we reviewed the effect of acupuncture stimulation on neuropeptides and hormones, including β-endorphin, serotonin, oxytocin, adrenocorticotropic hormone, gonadotropin-releasing hormone, corticotrophin-releasing hormone, cholecystokinin, and acetylcholine, as well as insulin sensitivity, immunomodulation (anti-inflammation), and autonomic nerve activity.