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.

[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 + Moxi) significantly reduced HOMA-IR (MD = 2.20, 95% CI 0.44-3.96; MD = 1.06, 95% CI 0.28-1.84). AIT, catgut implantation at acupoint (CIAA), and Acu reduced FINS (MD = 7.30, 95% CI 0.83-13.77; MD = 3.11, 95% CI 1.97-4.25; MD = 2.97, 95% CI 1.87-4.06). Acu + Moxi reduced BMI (MD = 5.80, 95% CI 3.38-8.22), and electroacupuncture (EA) reduced WHR (MD = 0.06, 95% CI 0.02-0.09). Laser acupuncture (LA) reduced T and LH (MD = 0.59, 95% CI 0.33-0.85; MD = 3.00, 95% CI 0.47-5.53). For ovarian morphology, warm needle therapy (WNT) and Acu reduced AFC (MD = 4.08, 95% CI 0.63-7.53; MD = 3.06, 95% CI 1.07-5.05), and Acu reduced ovarian volume (OV) (MD = 2.38, 95% CI 0.67-4.08). Overall, Acu ranked among the top interventions across multiple outcomes. Most reported adverse events were non-serious and transient. Adverse-event reporting was limited across trials.

[CONCLUSION] ARTs may be safe and effective complementary therapies for improving IR, reproductive endocrine outcomes, and ovarian morphology in women with PCOS.

[SYSTEMATIC REVIEW REGISTRATION] https://www.crd.york.ac.uk/PROSPERO/view/CRD420251151249, identifier CRD420251151249.