The Effectiveness of Letrozole-Electroacupuncture Adjuvant Therapy in Reducing Resistance and Pulsatility Indices in Women with Polycystic Ovarian Syndrome

Dhamayanti Eka Octavia, Uki Retno Budihastuti, Eriana Melinawati, Nutria Widya Purna Anggraini, Eric Edwin Yuliantara, Ida Nurwati, Cahyono Hadi


Background: Polycystic Ovarian Syndrome (PC­­­­OS) is a complex endocrine disorder and the cau­­­­se of 40% of infertility cases. In recent years, let­­­ro­zole as an aromatase inhibitor has been report­ed to be effective for ovulation induction. In addi­­tion, electro acupuncture therapy can redu­ce tonic activity in the sympa­thetic vaso­constric­tor path­­way to the uterus. This stu­dy aimed to determine the effectiveness of Let­ro­zo­le-Electroacupuncture adjuvant therapy in reducing the Resistance Index and Pul­sa­ti­li­ty Indices in women with Polycystic Ovary Syn­dro­me (PCOS).

Subjects and Method: This was an analytical ob­servational study with a cohort approach. The sub­jects of the study were women aged 20-45 years based on age, body mass index (BMI), and pe­riod of infertility aspects. The sample con­sisted of 30 people who were divided into 2 groups, name­­ly group 1 with letrozole therapy, while group 2 with additional electro­acu­punc­ture therapy and then carried out pre- and post-interven­tion exa­mi­nations on day 19 and 21. The depen­dent variables were the Resist­ance Index value and the Pulsaitility Index value. The inde­pendent vari­­ables were Letro­zole and Electro­acupuncture therapies. The Resistance and Pulsatility Indices we­re measured using USG transabdominal Color Dop­­pler Voluson P6. The data were analyzed using the Mann Whitney test.

Results: The Pul­satility Index for group 1 on day 21 (Mean= 2.69; SD= 0.87) was higher than group 2 (Me­an= 1.97; SD= 0.57), and it was statistically sig­ni­fi­cant (p= 0.013).

Conclusion: Letrozole-EA therapy reduce the Resistance and Pulsatility In­dices.

Keywords: Letrozole, acupuncture, endo­metrial re­ceptivity, Polycystic Ovarian Syndrome

Correspondence: Dhamayanti Eka Octavia. Department of Obs­tetrics and Gynecology, Faculty of Medicine, Universitas Sebelas Ma­­ret/ Dr. Moewardi Hos­pital, Sura­kar­ta 57126, Central Java. Email: dhama­yan­ti­ Mobile: 08125­0355886.

Journal of Maternal and Child Health (2020), 05(04): 422-429

Full Text:



Budihastuti UR, Melinawati E, Sulstyowati S, Nurwati I (2019). Electroacupuncture Effect on Polycystic Ovary Syndrome to Improve Oocytes’ Growth. Med Acu-punct. 31(6): 1–5.

Cheng KJ (2014). Neurobiological mechanisms of acupuncture for some common illnesses: A Clinician’s Perspective. J Acupunct Meridian Stud. 7(3): 105–114.

Christensen SB, Black MH, Smith N, Martinez MM, Jacobsen SJ, Porter AH, et al. (2013). Prevalence of polycystic ovary syndrome in adolescents. Fertil Steril. 100(2): 470–7.

Chuderland D, Ben-Ami I, Kaplan-Kraicer R, Grossman H, Ron-El R, Shalgi R (2013). The role of pigment epithelium-derived factor in the pathophysiology and treatment of ovarian hyperstimulation syndrome in mice. J Clin Endocrinol Metab. 98(2): E258–E266.

Elkattan EA (2013). Ultrasonographic markers of endometrial receptivity of letrozole and clomiphene citrate in un-explained infertile women. Middle East Fertility Society, 18(2): 84–88.

Farajzadeh F, Ghaderi F, Bastani P (2017). Treatment of polycystic ovarian syndrome using electroacupuncture: A case report. Int J Women's Health Reprod Sci. 5(1): 76–79.

Gao M, Zhao X, Li W, Liu G, Jia X (2007). Assessment of uterine receptivity by endometrial and subendometrial blood flows measured by vaginal color doppler ultrasound in women undergoing IVF treatment. J Reprod Contracept Obstet Gynecol: 18(3): 205-212.

Hung E, Ng Y, Chi C, Chan W, Tang OS, Shu W (2007). The role of endometrial blood flow measured by three dimensional power Doppler ultrasound in the prediction of pregnancy during in vitro fertilization treatment. Eur J Obstet Gynecol Reprod Biol.

(1): 8–16.

Kim A, Jung H, Choi WJ, et al. (2014). Detection of endometrial and subendometrial vasculature on the day of embryo transfer and prediction of pregnancy during fresh in vitro fertilization cycles. Taiwan J Obstet Gynecol, 53(3): 360–365.

Kusuma AC, Oktari N, Mihardja H, Srilestari A, Simadibrata CL, Hestiantoro A, Wiweko B, Muna N (2019). Electro acupuncture enhances number of mature oocytes and fertility rates for in vitro fertilization. Med Acupunct. 31(5): 289-297.

Lim CED, Ng RWC, Xu K (2016). Acupuncture for Sindrom Ovarium Polikistik. Cochrane Database Syst Rev. (5): CD0-07689.

Lopes Imrs, Maria CPB, Manuel DJB, Ricardo SS, Edmund CB, Jose SMJ (2011). Endometrium in women with polycystic ovary syndrome during the window of implantation. Rev Assoc Med Bras. 57(6): 702-209.

Ozkan S, Vural B, Calıskan E, Bodur H, Erkan Turkoz, Vural F (2007). Color doppler sonographic analysis of uterine and ovarian artery blood flow in women with polycystic ovary syndrome. J Clin Ultrasound. 35(6): 305-13.

Palihawadana TS, Wijesinghe PS, Seneviratne HR (2015). A comparison of endometrial thickness following aug-menttation of ovulation with clomifene citrate or letrozole in women with ovulatory infertility. Ceylon Med J. 60(2): 48–52.

Stener Victorin E, Wu X (2010). Effects and mechanisms of acupuncture in the reproductive system. Auton Neurosci Basic lin. 157(1–2): 46–51.

Waldman IN, Legro RS (2019). Polycystic Ovary Syndrome. The Ovary. 415-453.

Wang L, Wen X, Shulan L, Zhao J, Yang T, Yang X (2019). Comparison of endometrial receptivity of clomiphene citra-te versus letrozole in women with polycystic ovary syndrome: a randomized controlled study. Gynecol Endocrinol. 35(10):862-865.

Wiweko B, Mulya R. (2008). Profil resistensi insulin pada pasien sindrom ovarium polikistik (SOPK) di RS Dr. Cipto Mangunkusumo Jakarta. J Obstetri Ginekologi Indonesia. 32(2): 93-8.

Zhong Y, Zeng F, Liu W, Ma J, Guan Y, Song Y (2019). Acupuncture in improving endometrial receptivity: A systematic review and meta-analysis. BMC Complementary and Alternative Medicine. 19(1): 1–19.


  • There are currently no refbacks.