High acupuncture expectancy is associated with shorter time to ovulation and higher chances of ovulation in infertile patients with PCOS receiving acupuncture: a secondary analysis of a randomized controlled trial

Objective: To investigate the influence of acupuncture expectancy on fertility outcomes in infertile women with polycystic ovary syndrome (PCOS) receiving active or control acupuncture with or without clomiphene. Methods: This study was a secondary analysis of PolyCystic Ovary Syndrome Acupuncture plus Clomiphene Trial (PCOSAct), which was randomized controlled trial that recruited 1000 infertile patients with PCOS and randomly allocated them to receive active acupuncture or control acupuncture with or without clomiphene. Acupuncture expectancy data (measured on a scale from 4 to 20 points) were available in 827 women, who were subdivided into low expectancy and high expectancy groups (with scores <16 or ⩾16 points, respectively) after the third session of active or control acupuncture treatment. Anthropometric and endocrine parameters and fertility outcomes were compared. Kaplan–Meier curves were employed to evaluate the time to ovulation and live birth and a Cox regression model was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting by body mass index (BMI) and treatment group allocation in PCOSAct. Results: 373 and 454 patients were identified as having low and high expectancy, respectively. Compared with the low expectancy group, patients with high expectancy had been attempting to conceive for a shorter period (18 vs 24 months) and were more likely to have a prior history of acupuncture treatment (16.7% vs 10.7%). They also had an earlier menarche (13 vs 14 years), a higher BMI (23.8 vs 23.5 kg/m 2 ) and a lower estradiol level (194.5 vs 206.9 pmol/L). There was no interaction between acupuncture and acupuncture expectancy in terms of fertility outcomes. High expectancy was significantly associated with a shorter time to ovulation (35.0 vs 49.0 days) and higher chances of ovulation during the study period (HR: 1.3, 95% CI: 1.1–1.5). After adjusting for confounders, there were no significant between-group differences in any other outcomes, including conception, clinical pregnancy and live birth. Conclusion: High acupuncture expectancy was associated with a shorter time to ovulation and higher chances of ovulation in infertile patients with PCOS receiving active or control acupuncture in the PCOSAct trial. Trial registration number: NCT01573858 (ClinicalTrial.gov) and ChiCTR-TRC-12002081 (Chinese Clinical Trial Registry).