Objective:

2

To explore the effects of electroacupuncture (EA) on pregnancy outcomes after assisted reproduction and mitochondrial function of granulosa cells (GCs) in patients with polycystic ovary syndrome (PCOS) and phlegm-dampness syndrome.

Methods:

2

In this randomized controlled trial

90 infertile women with PCOS and phlegm-dampness syndrome were recruited between August 2022 and December 2022. Patients were randomly assigned to the EA and control groups using a random sequence of codes in the order of enrolment

with 45 in in each group. Both groups underwent the ovarian stimulation protocol. The patients in the EA group received EA therapy including Zhongwan (CV 12)

Qihai (CV 6)

bilateral Xuehai (SP 10)

Sanyinjiao (SP 6)

Yinlingquan (SP 9)

Tianshu (ST 25)

Zusanli (ST 36)

and Fenglong (ST 40)

and the patients in the control group was treated with pseudo-acupuncture. The intervention was 25 min twice a week for a total of 6 times until the trigger day after menstruation had ended in the cycle before oocyte retrieval. The primary outcomes were clinical pregnancy rate (CPR) and the number of high-quality embryos. The secondary outcomes were (1) pregnancy-related indicators

including fresh embryo transfer rate (ETR)

ovarian hyperstimulation syndrome (OHSS) rate

early pregnancy loss rate (ePLR)

ectopic pregnancy rate

live birth rate (LBR)

and cumulative CPR; (2) mitochondrial autophagy and mitochondrial membrane potential (MMP) in GCs; and (3) scoring for Chinese medicine syndrome. Adverse events to assess clinical safety were also monitored.

Results:

2

The cumulative CPR was significantly higher in the EA group (42/45

93.3%) than in the control group (38/45

84.4%

P

=0.036). The number of high-quality embryos and fresh ETR in the EA group were higher than those in the control group (3.80±1.65

vs

. 2.44±1.34

P

<

0.001; 46.7%

vs

24.4%

P

=0.028). Ectopic pregnancies were not observed in either group. There were no significant differences in the fresh CPR

OHSS rate

ePLR or LBR between the two groups (

P

>

0.05). Compared with the control group

the EA group showed lower expression levels of miR-146a-5p mRNA and P62 protein in GCs and higher levels of MMP and the LC3-Ⅱ/LC3-Ⅰ protein ratio (all

P

<

0.01). The phlegm-dampness syndrome scores of the EA group were significantly lower than those of the control group (

P

<

0.01).

Conclusions:

2

EA significantly improved pregnancy outcomes in patients with PCOS and phlegm dampness syndrome. Mechanistically

this effect may be related to EA in decreasing miR-146a-5p mRNA expression

promoting mitochondrial autophagy in GCs

and improving mitochondrial function

which may contribute to improved oocyte quality. (Trial registration No. ChiCTR2200062915)