Objective To compare the differences in functional connectivity(FC) between the hypothalamus and whole brain regions in patients with premature ovarian insufficiency(POI) and healthy volunteers based on resting-state functional magnetic resonance imaging(rs-fMRI) and investigate the mechanism of acupuncture on treatment of POI. Methods Twelve POI patients were recruited to the acupuncture group and 12 healthy volunteers to the control group. Patients in the acupuncture group received acupuncture at two groups of acupoints alternatively

including Baihui(GV20)

Zhongwan(CV12)

Shenting(GV24)

Shenshu(BL23)

Ciliao(BL32) and so on

30 min once time

3 times per week for 12 weeks. The state of patients was evaluated by modified Kupperman Index(KI) and self-rating anxiety scale(SAS). Follicle-stimulating hormone(FSH)

luteinizing hormone(LH)

estradiol(E_2)

and anti-mullerian hormone(AMH) were tested by microparticle-based chemiluminescence. B ultrasonography was used to detect the antral follicle count(AFC). Meanwhile

POI patients and healthy volunteers underwent the rs-fMRI examination before and after acupuncture treatment and after enrollment

respectively. With hypothalamus as the region of interest

the differences in FC between the hypothalamus and other brain regions in POI patients and healthy volunteers and the changes of FC between the hypothalamus and whole brain regions in POI patients before and after acupuncture were observed. Results The SAS and KI scores of pre-treatment POI patients were higher than those in the control group(P<0.01).In compa-rison with those pre-treatment

FSH

LH

and SAS and KI scores of POI patients decreased after treatment

while AFC increased(P<0.05). Compared with the control group

the FC of the left hypothalamus with left central sulcus

right middle occipital gyrus

and left paracentral lobule increased

but decreased with left globus pallidus of the lenticular nucleus in POI patients. Furthermore

the FC of the right hypothalamus with the left hippocampus

the left para-central lobule

and the right central sulcus increased

while the FC between the right hypothalamus and the right superior frontal gyrus decreased(P<0.05). For the acupuncture group

compared with the conditions before treatment

the FC of the right hypothalamus with the left inferior frontal gyrus

the left insula

and right inferior frontal gyrus was strengthened

but weakened with the left gyrus rectus(P<0.05). Conclusion The abnormal FC between the hypothalamus and whole brain regions may be one of the central pathological factors of POI. Acupuncture can improve the ovarian function and clinical symptoms of patients with POI

which may be related to its effect in regulating the FC between the hypothalamus and multiple brain regions.