The Application of Complementary and Alternative Medicine in Polycystic Ovary Syndrome Infertility Original paper

What was reviewed?

This comprehensive review article examines the current clinical evidence and mechanistic insights for complementary and alternative medicine (CAM) approaches in the management of infertility associated with polycystic ovary syndrome (PCOS). The review synthesizes findings from clinical trials, animal studies, and mechanistic research to evaluate the safety, efficacy, and potential mechanisms of traditional Chinese medicine (TCM), acupuncture (including electroacupuncture, moxibustion, and related modalities), nutrient supplementation (vitamins and trace elements), and lifestyle interventions such as diet, exercise, Tai Chi, yoga, and Qigong. The review emphasizes both the clinical outcomes and the biological pathways involved, particularly those relevant to metabolic, endocrine, and inflammatory regulation.

Who was reviewed?

The article analyzes a broad spectrum of studies, including randomized controlled trials (RCTs), cohort studies, and preclinical animal research. The reviewed populations primarily consist of reproductive-age women diagnosed with PCOS and infertility, as well as animal models (mainly rats) induced with PCOS-like phenotypes for mechanistic studies. The included studies span diverse geographic regions, with a heavy emphasis on Chinese clinical practice and research, but also incorporate international evidence on CAM use in PCOS. Subpopulations considered include patients with insulin resistance, obesity, or poor ovarian response, and studies often include comparison groups receiving conventional Western medical therapy.

Most important findings

The review identifies strong evidence that CAM modalities, particularly TCM herbal formulas and acupuncture, can improve reproductive and metabolic outcomes in women with PCOS-related infertility. Key TCM monomers such as berberine, cryptotanshinone, and quercetin, as well as compound prescriptions like Liu Wei Di Huang, Gui Zhi Fu Ling, Shou Tai Pill, and Zi Shen Yu Tai Pill, demonstrate efficacy in clinical trials by improving insulin resistance (IR), regulating sex hormone levels, reducing inflammation, and promoting follicle development. Several studies report that these interventions also modulate the gut microbiome and metabolic pathways (e.g., PI3K/AKT/mTOR, IRS-1/PI3K/GLUT4), suggesting a microbiome-endocrine-immune axis relevant to PCOS pathophysiology.

Notably, some studies link improvements in insulin sensitivity and reduction in inflammatory markers to alterations in the intestinal flora, providing a basis for further microbiome signatures research. Nutrient supplementation (vitamins D, E, and trace elements) and lifestyle modifications (weight loss, exercise, Tai Chi, yoga) also offer measurable benefits in ovulation, metabolic parameters, and psychological well-being.

Key implications

For clinicians, this review supports the integration of CAM as adjuncts to conventional fertility treatments for PCOS, particularly in patients with metabolic disturbances, poor response to ovulation induction, or those seeking alternatives due to adverse reactions to standard therapies. The mechanistic evidence for microbiome involvement highlights new avenues for personalized medicine and database development of microbial signatures associated with improved reproductive outcomes. While the safety profile for most CAM interventions is favorable, the review calls for greater standardization, larger-scale RCTs, and rigorous monitoring of potential adverse effects. Overall, CAM offers a promising, multifaceted approach to improve fertility outcomes and quality of life in PCOS, meriting further clinical adoption and research.