**Author details**

foot-taiyin. The main acupoints are distributed in the lower limbs, lower abdomen, and back [90]. In the special points, usage of front-mu points, five-shu points, and back-shu points are more frequently used and the prescription is usually an average of five to seven acupoints [90]. One prospective clinical study investigated responses to 5 weeks of EA in overweight-obese women with PCOS [91]. The results showed that HbA1c levels and circulating and adipose tissue androgens were significantly decreased, together with modulation of vagal activity and adipose tissue sympathetic activity [91]. A systematic review and meta-analysis demonstrated that manual acupuncture (MA) or EA can improve clinical pregnancy rates and ongoing pregnancy rates, and lower the risk of ovarian hyperstimulation syndrome (OHSS) in women with PCOS undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) [92]. Another RCT revealed that serum androgens decreased and menstrual frequency increased after 16 weeks of EA intervention, while the acne improved after the 16-week follow-up in the EA group compared to the exercise group [93]. The other RCT showed that serum levels of AMH were significantly decreased in the EA group compare with the change in the exercise group after 16 weeks of intervention, but there was no difference in the exercise group and the no intervention group at 32 weeks follow-up [94]. An earlier RCT found that abdominal acupuncture for obese patients with PCOS can reduce BMI and WHR and increase menstrual frequency more effectively, and

True (EA group) and sham (Park sham device group) acupuncture (EA V.S. Park sham device) may have similar effects on mean ovulation rates and reproductive endocrine changes, but the true acupuncture group could show lower fasting insulin and free testosterone levels after 8 weeks of intervention [96]. Another RCT showed that the utilization of acupuncture with or without clomiphene, compared with control acupuncture and placebo, did not increase live births in patients with PCOS [97]. A recent systematic review and meta-analysis demonstrated that acupuncture may be more likely to improve ovulation rates and menstruation frequency than no acupuncture in patients with PCOS [98]. This report also noted that acupuncture could be as an adjunct to medication with regard to LH, LH/FSH ratio, testosterone, fasting insulin, and pregnancy rates [98]. Another study revealed that there were very few RCTs have been reported and there was deficient evidence to support the use of acupuncture

Traditional Chinese medicine formulas or single herbs have been shown to be effective in many clinical or animal studies to restore regular menstruation, relieve symptoms, and improve ovulation dysfunction in patients with PCOS. Acupuncture, both EA and MA, have the potential to change the local ovarian hyperandrogenic environment and improve reproductive and endocrine metabolic disorders in PCOS. Thus, better outcomes can be achieved through complementary therapy with TCM for PCOS, expediting and boosting treatment efficacy, and ultimately leading to decreased medical costs. However, more clear, effective,

and safe evidence for the use of TCM management for PCOS is needed in the future.

with fewer adverse effects, than metformin after a 6-month trial [95].

for management of ovulation problems in patients with PCOS [99].

**7. Conclusions**

100 Debatable Topics in PCOS Patients

Yen-Nung Liao1 , Wen-Long Hu1,2,3 and Yu-Chiang Hung1,4\*

\*Address all correspondence to: hungyuchiang@gmail.com

1 Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Traditional Chinese Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan

2 Fooyin University College of Nursing, Kaohsiung, Taiwan

3 Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan

4 School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
