Effectiveness and safety of the combination of Chinese herbal medicine and acupuncture for women with polycystic ovarian syndrome: A systematic review and meta-analysis of randomized controlled trials

This systematic review aimed to evaluate the effectiveness and safety of Chinese herbal medicine (CHM) plus acupuncture for women with polycystic ovarian syndrome (PCOS). We searched for eligible randomized controlled trials (RCTs) in nine Chinese and English databases from their inception to May 7, 2023. The Cochrane "Risk of bias" tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods were used to assess the methodological quality and the certainty of the evidence. Effectiveness is presented as the risk ratio (RR) or mean difference with 95% confidence interval (CI). A total of 52 studies were included in this systematic review (n = 4180 participants). The overall quality of the RCTs was reduced by unclear or high risk of bias. The certainty of the evidence ranged from very low certainty to moderate certainty. None of the included studies reported the live birth rate. Among women with PCOS seeking fertility treatment, both CHM and acupuncture had a beneficial effect on the clinical pregnancy rate (CHM plus acupuncture (Intervention A), 9 RCTs, n = 754 participants, RR 1.28, 95% CI 1.10, 1.49; moderate certainty evidence; CHM plus acupuncture plus CMT (Intervention B), 16 RCTs, n = 1269 participants, RR 1.71, 95% CI 1.50, 1.94; moderate certainty evidence) and ovulation rate (Intervention A, 5 RCTs, n = 395 participants, RR 1.31, 95% CI 1.15, 1.49; low certainty evidence; Intervention B, 7 RCTs, n = 729 participants, RR 1.31, 95% CI 1.16, 1.48; low certainty evidence) compared to the control group. There is currently very low to moderate certainty evidence that CHM plus acupuncture can improve the fertility and clinical symptoms of PCOS patients. Further rigorous, double-blinded, placebo-controlled trials are needed to determine the effectiveness of complex interventions of CHM plus acupuncture for treating PCOS.