Acupuncture for DOR 2026

Stimulated by Wang et al 2026.[1]

DOR – diminished ovarian reserve
RCT – randomised controlled trial
IF – impact factor
CACMS – China Academy of Chinese Medical Sciences
AMH – anti-Müllerian hormone
AFC – antral follicle count
SAS – self-rating anxiety scale
IQR – interquartile range

– key to acronyms

This is a moderately large (n=120) RCT of acupuncture (both MA and EA) against a superficial penetrating same point sham control in women with DOR. It was published in International Journal of Women’s Health (IF 2.6) towards the beginning of April 2026, and it comes from CACMS in Beijing.

DOR in the female participants was defined based on the following parameters:

• Serum AMH <1.1 ng/ml
• AFC <5-7
• Basal serum FSH between 10 and 20 IU/L

There were other inclusion and exclusion criteria of course.

The acupuncture was performed for 20 minutes, 3 times a week for 12 weeks with an alternating protocol of points. Treatment was either performed supine or prone. The points used in the supine position were GV20, GV24, GB13, CV12, ST25, CV4, KI12, Zigong, SP6, and LR3. GB13 in in the anterior hairline on each side of GV24, 2/3 of the way from GV24 to ST8. KI12 and Zigong are both on the lower abdomen at the level of CV3 (1 cun below CV4). KI12 is 0.5 cun lateral and Zigong is 3 cun lateral.

The points used in the prone position were BL23, BL33, and KI3. EA was applied on each side from BL23 to BL33. BL33 was needled to a depth of 50mm to 60mm into the third sacral foramen. A mixed frequency was used (dense-dispersed), which is often 4Hz and 100Hz, although it is not specified here. The intensity was 1–5mA adjusted based on the patients’ comfort.

The sham involved the same points protocol but superficial insertion (1mm to 3mm) and no manual stimulation. EA was applied at <0.5mA).

So, essentially this is moderately strong acupuncture compared with gentle acupuncture at a high frequency of sessions. 3 sessions per week is about the maximum you can do in outpatients in China.

The primary outcome was the change from baseline AFC at 12 weeks. Secondary outcomes included the change from baseline AFC at 24 weeks and a bunch of the usual blood parameters, plus SAS scores.

AFC was defined as the number of follicles measuring 2–10mm in diameter on transvaginal US on day 2–5 of the menstrual cycle.

AFC increased in both groups with a significantly larger increase in the strong acupuncture group, although the absolute numbers are modest. The median (IQR) AFC increased from 4 (3 to 5) to 6 (4 to 8) in the strong acupuncture group and from 3 (2 to 4) to 4 (2.75 to 5.25) in the gentle acupuncture group.

The normal median AFC for a 36-year-old woman would be 10–14 and the inter-cycle variability might be plus or minus 1–3 follicles. Then there is the issue of inter-operator measurement error which could be up to 30%. In this study it was the same sonographer doing all the measurements, so we can probably overlook this aspect.

ChatGPT 5.4 suggests that a 50% increase in AFC sustained across cycles would be clinically meaningful.

There were no significant changes or differences in blood parameters although AMH rose fractionally and FSH dropped, but less than 30%.

SAS scores fell to a greater degree in the gentle acupuncture group. The absolute difference between groups was very highly statistically significant at week 24, which is interesting, but left undiscussed in the paper.

Given that the women received 36 sessions of acupuncture and only gained a couple of follicles, I would be losing interest in this as a viable approach to improving fertility in women with DOR.

References

1          Wang X, Du P, Yang L, et al. Effect of Acupuncture for Diminished Ovarian Reserve: A Randomized Sham-Controlled Trial. Int J Womens Health. 2026;18:580821. doi: 10.2147/IJWH.S580821

---

Declaration of interests MC