Clinical evidence of acupuncture for luteinized unruptured follicle syndrome: a systematic review and meta-analysis of randomized controlled trials

Ruifang Zhang¹Guangyao Lin²Wei Wang^1*

• ¹Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
• ²Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China

Background: To systematically assess the efficacy of acupuncture in women with luteinized unruptured follicle syndrome (LUFS) based on the existing randomized controlled trials (RCTs). Methods: A search of eight databases and one clinical trial database was conducted on May 03, 2025 to identify relevant RCTs appraising the benefits of acupuncture for LUFS. Clinical outcomes of interest included two primary outcomes and five secondary outcomes. Forest plots were used to illustrate the pooled results and sensitivity analyses were performed to verify the robustness of the evidence. Subgroup analysis was conducted to investigate whether the effect of acupuncture on the primary outcomes was related to the number of acupoints used per treatment. Additionally, Begg's and Egger's tests were done to quantitatively examine publication bias among studies. Results: 15 RCTs from China involving 1,030 participants with LUFS were included. According to the pooled results, acupuncture intervention effectively increased the ovulation rate by 25% (RD = 0.25, 95%CI [0.21, 0.30], p < 0.00001) and pregnancy rate by 22% (RD = 0.22, 95%CI [0.16, 0.28], p < 0.00001) compared to the control group. Besides, acupuncture treatment was more conducive to improving luteinizing hormone levels (MD = 3.76, 95%CI [2.27, 5.25], p < 0.00001), estradiol levels (SMD = 0.47, 95% CI [0.31, 0.63], p < 0.00001), progesterone levels (MD = 1.50, 95%CI [1.09, 1.91], p < 0.00001), resistance index (MD = -0.07, 95%CI [-0.09, -0.05], p < 0.00001) and pulsatility index (MD = -0.10, 95%CI [-0.15, -0.06], p < 0.00001) of the ovarian arteries. Subgroup analysis indicated a higher ovulation rate with stimulation of > 6 acupoints (28%) compared to ≤ 6 acupoints (19%); however, there was no notable association between the number of acupoints and pregnancy rate (22% vs. 23%). Furthermore, sensitivity analyses confirmed the robustness of the results, while both Begg's and Egger's tests indicated no significant publication bias across studies. Conclusions: This pooled evidence from Chinese RCTs reveals that acupuncture is a promising complementary therapy for LUFS. However, these findings might not be generalizable outside China, and most trials exhibited deficient methodological reporting.