Effect of acupoint catgut embedding therapy on polycystic ovary syndrome: a systematic review and meta-analysis

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder with limited optimal therapies. Acupoint catgut embedding (ACE) is widely used for PCOS, but evidence remains fragmented. This systematic review and meta-analysis aimed to: (1) evaluate the efficacy and safety of ACE in terms of overall efficacy rate, pregnancy rates, and insulin resistance (IR); (2) explore whether treatment effects vary by diagnostic criteria; and (3) assess evidence certainty using the Grading of Recommendations, Assessment, Development and Evaluation framework to inform standardized protocols.

Randomized controlled trials (RCTs) evaluating the efficacy and safety of ACE for PCOS were systematically retrieved from eight databases until September 1, 2024. Two investigators independently conducted study screening, data extraction, and risk-of-bias assessment. Meta-analyses were performed via Review Manager 5.4 and Stata 15.0.

Included were 77 RCTs on 5945 patients. ACE significantly improved overall treatment effectiveness (risk ratio [RR] = 1.24, 95% confidence interval [CI]: 1.20 to 1.28, P < 0.00001), increased pregnancy rates (RR = 1.65, 95% CI: 1.49 to 1.82, P < 0.00001), and reduced insulin resistance (mean difference [MD] = -0.38, 95% CI: -0.53 to -0.23, P < 0.00001). Adverse events (AEs) with ACE were mainly mild (e.g., bruising, transient pain), with significantly lower incidence than pharmacotherapy (RR = 0.57, 95% CI: 0.36 to 0.91, P = 0.02).

ACE may improve symptoms, pregnancy outcomes, and insulin sensitivity in PCOS patients with only mild adverse events. However, these findings should be interpreted with caution, given study limitations. Further RCTs are warranted to establish standardized protocols and identify optimal patient subgroups to verify the efficacy of ACE.