• He Y
• Chen X
• Lin J
• Wang H
• Wang B
• Xu J
• Lin Y

• Acupuncture Therapy
• Letrozole / therapeutic use
• Ovulation Induction
• Polycystic Ovary Syndrome / therapy
• Pregnancy Outcome

Objective: The purpose of this meta-analysis was to systematically review the effects of acupuncture with letrozole's effect on polycystic ovary syndrome (PCOS) ovulation and pregnancy outcomes.

Methods: We searched 7 electronic databases for clinical studies of acupuncture combined with letrozole for PCOS published until August 31, 2024. Meta-analysis was done using RevMan 5.4, while funnel plot symmetry was evaluated using Stata 16.0.

Results: Fifteen randomized controlled trials, encompassing 1311 cases, were included. The meta-analysis revealed that acupuncture combined with letrozole significantly improved the clinical efficacy rate (RR = 1.27, 95% CI [1.17, 1.37], P < .001), pregnancy rate (RR = 1.84, 95% CI [1.59, 2.13], P < .001), ovulation rate [RR = 1.30, 95% CI [1.18, 1.43], P < .001), endometrial thickness (MD = 1.05, 95% CI [0.76, 1.34], P < .00001), serum estradiol levels (MD = 8.34, 95% CI [6.71, 9.96], P < .001) and the rate of A-type endometrium (RR = 2.19, 95% CI [1.35, 3.55], P < .001). Additionally, it significantly reduced the miscarriage rate (RR = 0.20, 95% CI [0.08, 0.51], P < .001), serum luteinizing hormone levels (MD = -2.10, 95% CI [-3.58, -0.62], P < .001), serum testosterone levels (MD for treatment ≤3 menstrual cycles = -0.43, 95% CI [-0.49, -0.37], P < .001; MD for treatment >3 menstrual cycles = -3.06, 95% CI [-5.12, -0.99], P < .001), ovarian volume (MD = -2.21, 95% CI [-2.99, -1.43], P < .001), and TCM syndrome scores (MD = -4.33, 95% CI [-5.43, -3.24], P < .001). Begg's test for publication bias indicated some degree of bias (P ≤ .05).

Conclusion: Current evidence suggests that acupuncture combined with letrozole may be more effective for PCOS than letrozole alone; however, the quality of this evidence is low, necessitating further high-quality research to confirm these findings.

Protocol registration: Registered in PROSPERO on August 23 2024 (ID: CRD42024582344) .

Author keywords: Acupuncture; Letrozole; Meta-Analysis; Polycystic Ovary Syndrome; Systematic Review. 

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