Acupuncture has been demonstrated to improve menstrual frequency and to decrease circulating testosterone in women with polycystic ovary syndrome (PCOS). Our aim was to investigate whether acupuncture affects ovulation frequency and to understand the underlying mechanisms of any such effect by analyzing LH and sex steroid secretion in women with PCOS. This prospective, randomized, controlled clinical trial was conducted between June 2009 and September 2010. Thirty-two women with PCOS were randomized to receive either acupuncture with manual and low-frequency electrical stimulation or to meetings with a physical therapist twice a week for 10 -13 wk. Main outcome measures were changes in LH secretion patterns from baseline to after 10 -13 wk of treatment and ovulation frequency during the treatment period. Secondary outcomes were changes in the secretion of sex steroids, anti-Müllerian hormone, inhibin B, and serum cortisol. Ovulation frequency during treatment was higher in the acupuncture group than in the control group. After 10 -13 wk of intervention, circulating levels of estrone, estrone sulfate, estradiol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, testosterone, free testosterone, dihydrotestosterone, androsterone glucuronide, androstane-3␣,17␤-diol-3-glucuronide, and androstane-3␣,17␤-diol-17-glucuronide decreased within the acupuncture group and were significantly lower than in the control group for all of these except androstenedione. We conclude that repeated acupuncture treatments resulted in higher ovulation frequency in lean/overweight women with PCOS and were more effective than just meeting with the therapist. Ovarian and adrenal sex steroid serum levels were reduced with no effect on LH secretion. polycystic ovary syndrome; acupuncture; ovulation; lh pulsatility; sex steroids THE MAIN CHARACTERISTICS of polycystic ovary syndrome (PCOS) are polycystic ovaries (34), oligo/anovulation, and elevated serum levels of sex steroid precursors, estrogens, androgens, and glucuronidated androgen metabolites (38). PCOS is related to hyperinsulinemia and insulin resistance and is exacerbated by obesity (7). Numerous studies have reported hypersecretion of luteinizing hormone (LH) in women with PCOS (3). Together with an exaggerated ovarian response, hypersecretion of LH drives excessive ovarian androgen production and causes anovulation (13). In PCOS, altered sex steroid production, metabolic dysfunction, and obesity all contribute to changes in LH secretion patterns and to anovulation (6,12,29,30).Clomiphene citrate, exogenous gonadotropin therapy, and laparoscopic ovarian drilling are commonly used to induce ovulation in women with PCOS (1). These treatments often have negative side effects, thus indicating the importance of evaluating alternative treatments such as acupuncture. Acupuncture is used worldwide to achieve fertility, but its efficacy is supported by only limited scientific evidence. In a randomized controlled trial (RCT), we previously demonstrated that acupuncture w...

Studying the mechanisms for the complex pathogenesis of polycystic ovary syndrome (PCOS) requires animal models with endocrine, reproductive, and metabolic features of the syndrome. Hyperandrogenism seems to be a central factor in PCOS, leading to anovulation and insulin resistance. In female rats, continuous administration of letrozole, a nonsteroidal inhibitor of P450 aromatase, at 400 μg/d starting before puberty induces hyperandrogenemia and reproductive abnormalities similar to those in women with PCOS. However, despite high circulating testosterone levels, these rats do not develop metabolic abnormalities, perhaps because of their supraphysiological testosterone concentrations or because estrogen synthesis is completely blocked in insulin-sensitive tissues. To test the hypothesis that continuous administration of lower doses of letrozole starting before puberty would result in both metabolic and reproductive phenotypes of PCOS, we performed a 12-wk dose-response study. At 21 d of age, 46 female Wistar rats were divided into two letrozole groups (100 or 200 μg/d) and a control group (placebo). Both letrozole doses resulted in increased body weight, inguinal fat accumulation, anovulation, larger ovaries with follicular atresia and multiples cysts, endogenous hyperandrogemia, and lower estrogen levels. Moreover, rats that received 200 μg/d had insulin resistance and enlarged adipocytes in inguinal and mesenteric fat depots, increased circulating levels of LH, decreased levels of FSH, and increased ovarian expression of Cyp17a1 mRNA. Thus, continuous administration of letrozole, 200 μg/d, to female rats for 90 d starting before puberty results in a PCOS model with reproductive and metabolic features of the syndrome.

-Victorin E. Maternal androgen excess reduces placental and fetal weights, increases placental steroidogenesis, and leads to long-term health effects in their female offspring. Am J Physiol Endocrinol Metab 303: E1373-E1385, 2012. First published October 9, 2012 doi:10.1152/ajpendo.00421.2012.-Here, we tested the hypothesis that excess maternal androgen in late pregnancy reduces placental and fetal growth, increases placental steroidogenesis, and adversely affects glucose and lipid metabolism in adult female offspring. Pregnant Wistar rats were randomly assigned to treatment with testosterone (daily injections of 5 mg of free testosterone from gestational days 16 to 19) or vehicle alone. In experiment 1, fetal and placental weights, circulating maternal testosterone, estradiol, and corticosterone levels, and placental protein expression and distribution of estrogen receptor-␣ and -␤, androgen receptor, and 17␤-hydroxysteroid dehydrogenase 2 were determined. In experiment 2, birth weights, postnatal growth rates, circulating testosterone, estradiol, and corticosterone levels, insulin sensitivity, adipocyte size, lipid profiles, and the presence of nonalcoholic fatty liver were assessed in female adult offspring. Treatment with testosterone reduced placental and fetal weights and increased placental expression of all four proteins. The offspring of testosterone-treated dams were born with intrauterine growth restriction; however, at 6 wk of age there was no difference in body weight between the offspring of testosterone-and control-treated rats. At 10 -11 wk of age, the offspring of the testosterone-treated dams had less fat mass and smaller adipocyte size than those born to control rats and had no difference in insulin sensitivity. Circulating triglyceride levels were higher in the offspring of testosterone-treated dams, and they developed nonalcoholic fatty liver as adults. We demonstrate for the first time that prenatal testosterone exposure alters placental steroidogenesis and leads to dysregulation of lipid metabolism in their adult female offspring. testosterone; prenatal; maternal; placenta; polycystic ovary syndrome; insulin sensitivity; steroidogenesis; estrogen receptor; androgen receptor THE MATERNAL ENVIRONMENT may influence epigenetic processes during placental and fetal development that have long-lasting effects and lead to diseases such as hypertension, obesity, type 2 diabetes, and endocrine and reproductive dysfunction in adult offspring (6,24). Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age and is associated with hyperandrogenism, oligo/anovulation (infertility), and polycystic ovaries (5, 26). PCOS is also associated with metabolic disturbances such as hyperinsulinemia and type 2 diabetes and dysfunctional lipid profile, symptoms that are aggravated by obesity (5). Women with PCOS are at a higher risk of delivering prematurely, developing gestational diabetes and preeclampsia (33), and having both small-for-gestational-age (40) and large-for-...

Polycystic ovary syndrome (PCOS), the most common endocrine disorder among women of reproductive age, is characterized by the coexistence of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries (PCO). PCOS also represents the largest part of female oligoovulatory infertility, and the management of ovulatory and menstrual dysfunction, comprises a third of the high costs of PCOS treatment. Current pharmacological and surgical treatments for reproductive symptoms are effective, however, associated with negative side effects, such as cardiovascular complications and multiple pregnancies. For menstrual irregularities and ovulation induction in women with PCOS, acupuncture has indicated beneficial effects. This review will focus on the results from randomized controlled acupuncture trials for regulation of menstrual dysfunction and for inducing ovulation in women with PCOS although there are uncontrolled trials with nonetheless interesting results. Animal experimental studies will be further discussed when they can provide a more mechanistic explanatory view.

Intense electroacupuncture normalizes insulin sensitivity, increases muscle GLUT4 content, and improves lipid profile in a rat model of polycystic ovary syndrome. Am J Physiol Endocrinol Metab 299: E551-E559, 2010. First published July 27, 2010; doi:10.1152/ajpendo.00323.2010.-Polycystic ovary syndrome (PCOS) is associated with hyperandrogenism and insulin resistance, possibly reflecting defects in skeletal muscle and adipocyte insulin signaling. Low-frequency (2 Hz) electroacupuncture (EA) increases insulin sensitivity in female rats with dihydrotestosterone (DHT)-induced PCOS, but the mechanism is unclear. We hypothesized that low-frequency EA regulates mediators involved in skeletal muscle glucose uptake and metabolism and alters the lipid profile in rats with DHT-induced PCOS. To test this hypothesis, we implanted in prepubescent female rats 90-day continuousrelease pellets containing DHT (PCOS). At 70 days of age, the rats were randomly subdivided into two groups: one received lowfrequency EA (evoking muscle twitches) for 20 -25 min five times/wk for 4 -5 wk; the other did not. Controls were implanted with pellets containing vehicle only. All three groups were otherwise handled similarly. Lipid profile was measured in fasting blood samples. Insulin sensitivity was determined by euglycemic hyperinsulinemic clamp, soleus muscle protein expression of glucose transporter 4 (GLUT4), and phosphorylated and nonphosphorylated Akt, and Akt substrate of 160 kDa was determined by Western blot analysis and GLUT4 location by immunofluorescence staining. PCOS EA rats had normalized insulin sensitivity, lower levels of total high-density lipoprotein and low-density lipoprotein cholesterol, and increased expression of GLUT4 in different compartments of skeletal muscle compared with PCOS rats. Total weight and body composition did not differ in the groups. Thus, in rats with DHT-induced PCOS, low-frequency EA has systemic and local effects involving intracellular signaling pathways in muscle that may, at least in part, account for the marked improved insulin sensitivity.acupuncture; glucose transporter 4; insulin resistance; muscle contraction; skeletal muscle HYPERANDROGENEMIA IS THE MOST PROMINENT endocrine phenotype in women with polycystic ovary syndrome (PCOS) (56) in addition to ovulatory dysfunction and polycystic ovary morphology (3). The main metabolic phenotype is hyperinsulinemia and insulin resistance, which are independent of body weight (19,40). Other metabolic abnormalities associated with insulin resistance are obesity, dyslipidemia, and increased risk for type 2 diabetes.The mechanisms for the association between endocrine and metabolic abnormalities in PCOS are unclear (13, 18). PCOS is characterized by clinical and/or biochemical hyperandrogenism. In female rats and humans, exogenous exposure to testosterone or dihydrotestosterone (DHT) leads to insulin resistance and obesity (4,14,17,22,50,58). The insulin resistance in women with PCOS is associated with a dyslipidemia characterized by low levels of high...