Effect of acupuncture on assisted reproduction treatment outcomes

This randomized controlled trial investigated the effect of acupuncture on outcomes of assisted reproduction treatments, specifically intracytoplasmic sperm injection (ICSI). The research was conducted in São Paulo, Brazil, and enrolled 416 women aged 35 years or younger who were undergoing their first ICSI cycle. Acupuncture has been considered a promising complementary technique in the management of infertility, with potential physiological and psychological effects that may reduce stress in women undergoing fertility treatment. The methodology involved randomizing patients into two groups: a control group (208 patients) that received only standard assisted reproduction treatment, and an acupuncture group (208 patients) that received two 25-minute acupuncture sessions, one immediately before and another immediately after embryo transfer.

The acupuncture points were selected based on previous studies and included PC-6, SP-8, LR-3, GV-20, and ST-29 before transfer, and ST-36, SP-6, SP-10, and LI-4 after transfer. According to traditional Chinese medicine, stimulation of these specific meridians improves blood perfusion and energy to the uterus and promotes relaxation during the procedure. The overall results did not demonstrate a significant influence of acupuncture on pregnancy, implantation, miscarriage, or live birth rates when the entire study population was analyzed. Pregnancy rates were 40.4% in the acupuncture group versus 32.2% in the control group, a difference that did not reach statistical significance.

However, a subgroup analysis revealed interesting results. When cycles in which the causes of infertility were exclusively tubal-uterine or idiopathic were evaluated separately (77 patients in total), a positive effect of acupuncture was observed. In this specific subgroup, acupuncture increased the chance of pregnancy more than fivefold (OR = 5.15; 95% CI: 1.03–34.5). This finding suggests that acupuncture may be more effective when the embryo is not affected by ovarian or seminal factors, indicating a possible effect of acupuncture on endometrial receptivity.

The researchers discuss that the mechanism by which acupuncture may influence uterine receptivity is related to increased blood flow to the uterus and ovaries, as well as central sympathetic inhibition through the endorphin system. The clinical implications suggest that, although acupuncture does not demonstrate a universal benefit for all ICSI cases, it may have a specific role in situations where infertility is not related to ovarian or male factors. An important limitation of the study was the inability to fully blind participants, since the control group did not receive any intervention, which may have introduced a placebo effect. The authors acknowledge that future studies with control groups receiving sham acupuncture would be more appropriate to eliminate this bias.

The study contributes to the growing body of evidence on acupuncture in assisted reproduction, an area that remains controversial in the medical literature.