Acupuncture to ensure high-quality embryos in women undergoing in vitro fertilization: A systematic review and meta-analysis

This systematic review and meta-analysis represents the first comprehensive study focused specifically on the impact of acupuncture on oocyte and embryo quality during in vitro fertilization (IVF). Investigators analyzed 18 randomized controlled trials involving 1,506 infertile women undergoing controlled ovarian stimulation.

The methodology was rigorous, following PRISMA guidelines and including searches in eight international databases. The included studies compared IVF with acupuncture (manual or electroacupuncture) versus IVF alone or with placebo acupuncture. The most frequently used acupuncture points included SP-6 (Sanyinjiao), CV-4 (Guanyuan), and ST-29 (Guilai), known in traditional Chinese medicine for nourishing blood, strengthening the kidneys, and regulating the uterus.

The main results demonstrated that acupuncture significantly improved the high-quality embryo rate by 76% (OR=1.76, 95% CI 1.30-2.39), with moderate-certainty evidence. The fertilization rate also increased by 47% (OR=1.47, 95% CI 1.19-1.82), while the high-quality oocyte rate improved by 139% (OR=2.39, 95% CI 1.42-4.02), although this latter result has low-certainty evidence due to heterogeneity.

One of the most important findings was the identification of two fundamental principles for optimizing acupuncture treatment. First, the patient-stratified effect: the increase in number of oocytes retrieved was exclusive to women with elevated FSH levels (≥25 mIU/mL), indicating severely compromised ovarian reserve. Second, outcome-dependent dosing: embryo quality benefited from short courses (5-8 sessions), whereas oocyte yield required longer regimens (12-24 sessions).

Subgroup analysis revealed that older women (≥35 years) with diminished ovarian reserve obtained the greatest benefits, but when adjusted for FSH levels, chronological age was not the determining factor. This suggests that functional ovarian reserve, not age per se, is the primary predictor of treatment response.

From a mechanistic standpoint, acupuncture appears to modulate the hypothalamic-pituitary-ovarian axis, improve ovarian blood flow, reduce oxidative stress, and regulate gonadotropic hormone release. These effects create a more favorable microenvironment for folliculogenesis and high-quality embryo development.

The clinical implications are significant. For patients with infertility, especially those with diminished ovarian function, acupuncture offers a safe, non-toxic, and relatively cost-effective adjuvant therapeutic option. Compared with increasing gonadotropin doses or use of growth hormone, acupuncture has lower cost and no significant side effects.

Limitations include risk of bias due to insufficient reporting of allocation concealment in many studies, clinical heterogeneity in acupuncture techniques and electroacupuncture parameters, and limited number of studies for some outcomes such as high-quality oocyte rate. The lack of standardization in the reporting of some outcomes also affected the ability to pool data.

This study establishes acupuncture as effective adjuvant therapy to improve embryo quality in assisted reproductive technology, moving beyond a one-size-fits-all approach toward personalized treatment protocols based on precise patient stratification.