Effect of Acupuncture for Diminished Ovarian Reserve: A Randomized Sham-Controlled Trial

Objective: Acupuncture is a potential intervention for diminished ovarian reserve (DOR); however, the evidence remains limited. This single-center, randomized, sham-acupuncture controlled trial was conducted to evaluate the efficacy and safety of acupuncture in treating DOR. Methods: A total of 120 DOR patients aged 18– 40 years were randomized to receive acupuncture or sham acupuncture. The treatment lasted 12 weeks, with 20-minute sessions three times weekly, followed by a 12-week follow-up. The primary outcome was the change in antral follicle count (AFC) from baseline to week 12. Secondary outcomes included serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E 2 ), menstrual cycle length, and self-rating anxiety scale (SAS) scores. Results: Of the participants, 108 completed the study. Both acupuncture and sham acupuncture interventions exhibited statistically significant increases in AFC at weeks 12 and 24 versus baseline. The acupuncture group had significantly higher AFC values compared to sham controls at both evaluation timepoints. At week 12, the acupuncture group showed a significantly greater increase in AFC (median IQR, 2.00 0 to 4.00) compared to the sham group (0 0 to 0.25), with a between-group pseudo-median difference of 1.00 (95% CI, 0 to 2.00; p=0.003). By week 24, although improvements in AFC persisted, between-group differences became non-significant. Both groups demonstrated increases in AMH and decreases in FSH at weeks 12 and 24 compared to baseline, though between group comparisons revealed no statistically significant differences. There were no significant differences between groups in E 2 , LH, and menstrual cycle length. A statistically significant between-group difference in SAS was noted exclusively at week 24. Treatment related adverse events were mild and infrequent. Conclusion: A 12-week of acupuncture significantly improved AFC in women with DOR compared to sham acupuncture. Further large-scale studies are warranted to confirm these findings and assess long-term outcomes. Keywords: acupuncture, diminished ovarian reserve, randomized controlled trial, sham acupuncture, antral follicle count