An Overview of Systematic Reviews of Acupuncture for Infertile Women Undergoing in vitro Fertilization and Embryo Transfer

Assisted reproduction has become an increasingly common option for couples facing difficulty conceiving. Among the various treatments available, in vitro fertilization with embryo transfer (IVF-ET) represents one of the most advanced techniques in reproductive medicine. In parallel, many couples seek complementary therapies, such as acupuncture, to increase their chances of success. Acupuncture, an ancient technique of traditional Chinese medicine that involves the insertion of fine needles at specific body points, has gained increasing attention as a possible adjunct to fertility treatments.

Interest in this combination arises from the need to improve IVF-ET success rates, which still show variable outcomes worldwide, and from the potential benefits acupuncture may offer in balancing hormones, improving blood flow to reproductive organs, and reducing the stress associated with fertility treatments.

This study represents a comprehensive review of 16 systematic reviews published between 2008 and 2020, analyzing the effects of acupuncture in women undergoing IVF-ET. The primary objective was to assess the efficacy and safety of acupuncture as a complementary treatment, specifically examining clinical pregnancy rates, live births, biochemical pregnancy, ongoing pregnancy, and miscarriage. The methodology followed rigorous scientific standards, including a systematic search across eight international and Chinese databases without language restrictions, covering studies from database inception through July 2020. Researchers used internationally recognized tools to assess the methodologic quality of included studies, such as AMSTAR-2 and the GRADE system to rate the strength of scientific evidence.

A total of 312 original randomized controlled trials were included, encompassing 65,388 participants, representing one of the most extensive analyses ever conducted on this topic.

The main results revealed promising findings, but with important limitations. When compared with the sham acupuncture (placebo) control group, true acupuncture proved superior in increasing the clinical pregnancy rate, with a 31% increase in the probability of pregnancy. When compared with no additional treatment, acupuncture demonstrated even more pronounced benefits, increasing the clinical pregnancy rate by 25% and the ongoing pregnancy rate by 38%. In addition, acupuncture treatment was more effective in reducing miscarriage and biochemical pregnancy rates when compared with no additional treatment.

However, no statistically significant differences were observed in live birth rates when acupuncture was compared with sham acupuncture. Subgroup analysis revealed that women under 35 years old obtained better treatment outcomes, suggesting that age may be a determining factor in the efficacy of acupuncture for fertility.

The clinical implications of these findings are relevant for both patients and healthcare professionals. For women undergoing IVF-ET treatment, the results suggest that acupuncture may offer additional benefits, especially in increasing the chances of clinical pregnancy. The treatment proved to be safe, with few reports of mild adverse effects such as nausea, dizziness, or local discomfort. For practitioners, the data indicate that acupuncture can be considered a safe complementary therapy, particularly for younger women.

The technique is traditionally applied before and after embryo transfer, following established protocols that involve sessions of 25 to 30 minutes. The proposed mechanism of action includes improvement of hormonal balance, increased blood flow to reproductive organs, reduced uterine motility, and decreased stress levels, factors that can contribute to a more favorable environment for embryo implantation and pregnancy maintenance.

However, this study also identified important limitations that should be considered when interpreting the results. The methodologic quality of the systematic reviews analyzed was rated as critically low by AMSTAR-2 criteria, primarily due to lack of prior protocol registration, incomplete literature search, and inadequate risk-of-bias assessment. Significant heterogeneity was observed among studies, reflecting differences in acupuncture protocols used, treatment timing, types of controls, and outcome criteria. The quality of scientific evidence was rated as moderate to very low by the GRADE system, limiting the reliability of conclusions.

Additionally, there is the inherent challenge of conducting truly blinded acupuncture studies, since it is difficult to fully mask this type of intervention for both patients and therapists.

Considering these limitations, the authors conclude that, although acupuncture appears to offer benefits for increasing clinical pregnancy rates in women undergoing IVF-ET, current evidence is still insufficient to establish definitive recommendations. Significant heterogeneity among studies and the methodologic problems identified limit the reliability of the results. Therefore, there is an urgent need for high-quality primary studies with larger samples and more rigorous methodology to definitively establish the role of acupuncture in reproductive medicine. Future research should focus on standardized acupuncture protocols, better characterization of populations that benefit most from treatment, and investigation of the mechanisms of action involved.

In the meantime, patients interested in acupuncture as a complementary therapy should discuss this option with their physicians, considering both the potential benefits and the limitations of current scientific evidence.