Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome : A Randomized Clinical Trial

Key Points

Question

Does acupuncture alone or combined with clomiphene increase the likelihood of live births among women with polycystic ovary syndrome?

Findings

In this randomized clinical trial that recruited 1000 Chinese women with polycystic ovary syndrome, the live birth rate was significantly higher in the group of women who received clomiphene compared with placebo (28.7% vs 15.4%, respectively). However, it was not significantly different between the groups who received active vs control acupuncture (21.8% vs 22.4%, respectively), and there was no significant interaction between active acupuncture and clomiphene.

Meaning

Acupuncture, alone or with clomiphene, was not effective as an infertility treatment in women with polycystic ovary syndrome.

Abstract

This 2 × 2 factorial trial compared the effects of active vs sham acupuncture and of clomiphene vs placebo on live births among Chinese women with polycystic ovary syndrome (PCOS).

Abstract

Importance

Acupuncture is used to induce ovulation in some women with polycystic ovary syndrome, without supporting clinical evidence.

Objective

To assess whether active acupuncture, either alone or combined with clomiphene, increases the likelihood of live births among women with polycystic ovary syndrome.

Design, Setting, and Participants

A double-blind (clomiphene vs placebo), single-blind (active vs control acupuncture) factorial trial was conducted at 21 sites (27 hospitals) in mainland China between July 6, 2012, and November 18, 2014, with 10 months of pregnancy follow-up until October 7, 2015. Chinese women with polycystic ovary syndrome were randomized in a 1:1:1:1 ratio to 4 groups.

Interventions

Active or control acupuncture administered twice a week for 30 minutes per treatment and clomiphene or placebo administered for 5 days per cycle, for up to 4 cycles. The active acupuncture group received deep needle insertion with combined manual and low-frequency electrical stimulation; the control acupuncture group received superficial needle insertion, no manual stimulation, and mock electricity.

Main Outcomes and Measures

The primary outcome was live birth. Secondary outcomes included adverse events.

Results

Among the 1000 randomized women (mean [SD] age, 27.9 [3.3] years; mean [SD] body mass index, 24.2 [4.3]), 250 were randomized to each group; a total of 926 women (92.6%) completed the trial. Live births occurred in 69 of 235 women (29.4%) in the active acupuncture plus clomiphene group, 66 of 236 (28.0%) in the control acupuncture plus clomiphene group, 31 of 223 (13.9%) in the active acupuncture plus placebo group, and 39 of 232 (16.8%) in the control acupuncture plus placebo group. There was no significant interaction between active acupuncture and clomiphene ( P = .39), so main effects were evaluated. The live birth rate was significantly higher in the women treated with clomiphene than with placebo (135 of 471 [28.7%] vs 70 of 455 [15.4%], respectively; difference, 13.3%; 95% CI, 8.0% to 18.5%) and not significantly different between women treated with active vs control acupuncture (100 of 458 [21.8%] vs 105 of 468 [22.4%], respectively; difference, −0.6%; 95% CI, −5.9% to 4.7%). Diarrhea and bruising were more common in patients receiving active acupuncture than control acupuncture (diarrhea: 25 of 500 [5.0%] vs 8 of 500 [1.6%], respectively; difference, 3.4%; 95% CI, 1.2% to 5.6%; bruising: 37 of 500 [7.4%] vs 9 of 500 [1.8%], respectively; difference, 5.6%; 95% CI, 3.0% to 8.2%).

Conclusions and Relevance

Among Chinese women with polycystic ovary syndrome, the use of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births. This finding does not support acupuncture as an infertility treatment in such women.

Trial Registration

clinicaltrials.gov Identifier: NCT01573858