Evidence behind this recommendation.
Selected studies from our library that inform the recommendations on this page. Evidence grade shown when available.
The effects of acupuncture on the secondary outcomes of anxiety and quality of life for women undergoing IVF: A randomized controlled trial
“Acupuncture has been increasingly sought by women undergoing in vitro fertilization treatments, both in the hope of improving their chances of pregnancy and as a way to relieve the emotional stress that accompanies the process....”
Effect of Acupuncture vs Sham Acupuncture on Live Births Among Women Undergoing In Vitro Fertilization: A Randomized Clinical Trial
“This double-blind randomized controlled trial was conducted to determine whether acupuncture can improve live birth rates in women undergoing in vitro fertilization (IVF). Published in the prestigious journal JAMA in 2018, it represents a...”
IVF and the Factors That Determine Success
In vitro fertilization (IVF) is the most effective treatment for infertility of multiple causes: tubo-peritoneal factor, endometriosis, severe male factor, and failure of other treatments. In Brazil, the clinical pregnancy rate per fresh embryo transfer ranges from 30%–45% per cycle — depending on age, ovarian reserve, and embryo quality. This means that 55%–70% of cycles do not result in pregnancy, and the search for strategies to improve these rates is active and legitimate.
How the IVF Cycle Works
Understanding the phases of the IVF cycle helps clarify where acupuncture can intervene most strategically. The standard long protocol (GnRH agonist) lasts 4–6 weeks; the antagonist protocol is shorter (2–3 weeks).
IVF CYCLE PHASES AND ACUPUNCTURE INTERVENTION
| PHASE | WHAT HAPPENS | ROLE OF ACUPUNCTURE |
|---|---|---|
| Pituitary suppression (agonist/antagonist) | Suppression of spontaneous ovulation to control the cycle | Acupuncture for stress reduction; improvement in pre-cycle sleep and anxiety |
| Ovarian stimulation (FSH/hMG) | Multiple follicular growth monitored by US and estradiol | ST-29 to support ovarian blood flow; improvement in the follicular environment |
| Follicular puncture | Aspiration of follicles under anesthesia; oocyte retrieval | Acupuncture 24 h before may reduce acute stress and improve follicular quality |
| Embryo transfer | Embryo positioned in the uterus by catheter; critical moment | Specific protocol: acupuncture before (25 min) and after (25 min) transfer — reduces uterine contractility and improves blood flow |
| Luteal phase (progesterone support) | Vaginal/oral progesterone for endometrial support | CV-4, SP-6, KI-3 — Yin and Kidney support; reduces the anxiety of the post-transfer "wait" |
How Acupuncture Works in IVF Support
Mechanisms in IVF Support
Improvement of Uterine Blood Flow
ST-29 (over the ovaries) and SP-6 (tibial) may modulate flow in the uterine arteries (reduction of PI and RI on uterine Doppler in specific studies). Some Doppler studies suggest increased uterine flow after acupuncture — a hypothesized mechanism via vasodilation mediated by nitric oxide and vasoactive neuropeptides (VIP, CGRP).
Reduction of Uterine Contractility
GV-20 and PC-6 may modulate uterine sympathetic tone — associated with the contractions that can impair embryo implantation. Acupuncture performed 25 minutes before transfer was associated with a reduction in the frequency of uterine contractions in studies using hysteroscopy.
Stress Modulation: Cortisol and Beta-Endorphin
The IVF process can elevate serum cortisol — a hormone that appears to inhibit the expression of endometrial integrins relevant to implantation. PC-6, HT-7, and GV-20 may activate the opioidergic system, contributing to lower cortisol and modulation of HPA (hypothalamic-pituitary-adrenal) axis activity.
Improvement of Follicular Quality
Acupuncture during the ovarian stimulation phase may modulate the cytokine profile of follicular fluid (reduction of TNF-alpha, increase in IGF-1 in specific studies) — a potentially more favorable environment for oocyte development. Modulated ovarian flow may contribute to follicular oxygenation.
Main Points in the IVF Protocol
ST29 — Guilai (Ovarian-Uterine Support)
Point over the inguinal ligament, accessing uterine vascular innervation. Increased flow in the uterine and arcuate arteries documented by Doppler. Used during ovarian stimulation and in the early luteal phase.
SP8 + CV4 — Endometrial Environment Support
SP8 may modulate endometrial perfusion; CV4, in traditional approaches, is referred to as a uterus-related point. A classic combination used for endometrial support — some studies suggest correlation with pre-transfer endometrial thickness and homogeneity.
Scientific Evidence: An Evolving Field
Acupuncture in IVF is one of the most studied areas of integrative reproductive medicine. The field was opened by the seminal trial of Paulus et al. (Fertil Steril, 2002), which showed a 16% increase in pregnancy rate with acupuncture on the day of transfer. Since then, more than 30 RCTs and 5 meta-analyses have investigated this association.
Modern Acupuncture Protocol for IVF Support
4 Weeks Before
Preparation of the endometrial environment and reduction of baseline stress. 2 sessions/week focusing on ST29, SP6, CV4, PC6. Baseline assessment of uterine Doppler.
When to See a Medical Acupuncturist
Priority Indications
IVF with previous implantation failure; thin endometrium (<7 mm) in previous cycles; uterine Doppler with elevated PI; intense anxiety during the IVF process; associated endometriosis; PCOS with insulin resistance.
Communication with the Reproductive Specialist
The medical acupuncturist should communicate the protocol to the reproductive medicine specialist. Sessions are timed according to the IVF cycle calendar. No drug interactions described with the medications of the stimulation protocol; decision made jointly with the specialist.
Frequently Asked Questions
Frequently Asked Questions
Yes — and this is precisely the protocol with the strongest evidence. Two higher-quality studies (n=640 and n=230) show improvement in the implantation rate with 25-minute sessions before and 25 minutes after the transfer. The first session reduces uterine contractility and peri-transfer stress; the second supports early implantation. Ideally, the medical acupuncturist is in the same clinic or performs the sessions in an office near the assisted-reproduction clinic.
No drug interactions have been described with standard IVF medications (GnRH agonists/antagonists, recombinant FSH, hCG, vaginal or oral progesterone). Acupuncture is a mechanical intervention (needles) and has no direct pharmacological action. The reproductive medicine specialist should always be informed — the clinical decision is made jointly.
The most comprehensive meta-analysis (HRU 2020, n=5,807) shows an RR of clinical pregnancy of 1.12 — that is, approximately 12% relative improvement. At a baseline rate of 35%, this would represent about 4 percentage points (35% to 39%). This is a modest but consistent benefit in meta-analysis; the individual response should be individualized, and acupuncture has a favorable safety profile when performed by a medical acupuncturist, with adverse effects generally mild (local hematoma, discomfort, rarely syncope).
Yes, and this phase — called the "two week wait" (TWW) — is perhaps where acupuncture offers the most clinical comfort. The intense anxiety of this wait elevates cortisol, which can compromise early implantation. Sessions 2–3 times per week with PC-6, HT-7, GV-20, SP-6, and KI-3 promote relaxation, improve sleep, and reduce the acute stress of the waiting period.