The effects of acupuncture on pregnancy outcomes of in vitro fertilization: a systematic review and meta-analysis
Xie et al. · BMC Complementary and Alternative Medicine · 2019
Evidence Level
MODERATEOBJECTIVE
Evaluate the effects of acupuncture on pregnancy rates in in vitro fertilization
WHO
6,116 women undergoing in vitro fertilization
DURATION
27 studies analyzed through December 2018
POINTS
Varied manual acupuncture and electroacupuncture protocols
🔬 Study Design
Acupuncture + IVF
n=3058
Manual acupuncture or electroacupuncture + IVF
Control + IVF
n=3058
IVF without acupuncture or sham acupuncture
📊 Results in numbers
Clinical pregnancy rate
Live birth rate
Benefit in repeat IVF attempts
Effect with multiple sessions
Percentage highlights
📊 Outcome Comparison
Clinical pregnancy rate
Live birth rate
This analysis of 27 studies shows that acupuncture may increase the chances of pregnancy in in vitro fertilization treatments, especially in women who have had prior unsuccessful attempts. The benefit is most evident when multiple acupuncture sessions are performed.
Article summary
Plain-language narrative summary
This study represents a comprehensive analysis of the effects of acupuncture on in vitro fertilization (IVF) outcomes — one of the most extensive systematic reviews ever conducted on the subject. The investigators analyzed 27 randomized controlled trials involving 6,116 women undergoing IVF treatment, seeking to clarify the existing controversy in the medical literature about the efficacy of acupuncture in this setting.
The methodology employed was rigorous, including searches of multiple medical databases and quality assessment of studies according to international criteria. The authors performed meta-regression and subgroup analyses based on eight pre-specified covariates to investigate the sources of heterogeneity between studies and identify factors influencing the efficacy of acupuncture.
The primary results showed that acupuncture significantly increased the clinical pregnancy rate by 21% (RR = 1.21; 95% CI: 1.07-1.38) compared with control groups. However, there was no statistically significant difference in the live birth rate, which raises important questions about the translation of early pregnancy results into successful final outcomes.
The most revealing aspect of the study was the subgroup analysis, which identified two key variables that significantly modify the effects of acupuncture. First, women with a history of prior unsuccessful IVF attempts (≥50% of the group) showed much more pronounced benefits, with a 60% increase in clinical pregnancy rate (RR = 1.60; 95% CI: 1.28-2.00) and 42% in live birth rate (RR = 1.42; 95% CI: 1.05-1.92). This finding suggests that acupuncture may be particularly effective in cases of recurrent implantation failure.
Second, the number of acupuncture sessions proved crucial for efficacy. Women who received multiple acupuncture sessions had significantly better outcomes in clinical pregnancy rate (RR = 1.60; 95% CI: 1.32-1.92) compared with those who received only one session. This finding has important practical implications for treatment protocol planning.
The meta-regression analysis revealed that the proportion of repeat IVF cycles explained 100% of the heterogeneity between studies for clinical pregnancy rate and 87.90% for live birth rate, indicating that this is the main source of variation in results across different studies. Similarly, the number of acupuncture treatments explained 51.90% of the observed heterogeneity.
From the standpoint of mechanisms of action, the authors discuss several theories that may explain the observed benefits. Acupuncture may improve IVF outcomes through regulation of the hypothalamic-pituitary-ovarian axis, improvement in uterine and ovarian blood flow, and reduction of stress and anxiety associated with assisted reproduction procedures. These mechanisms may be particularly relevant in women with a history of prior failure, who often present greater vulnerability to stress and possible endometrial receptivity problems.
The clinical implications are significant. The study suggests that acupuncture may be offered as adjuvant therapy in IVF protocols, especially for women with prior unsuccessful attempts. The optimal protocol appears to involve multiple sessions, although the authors acknowledge that further research is needed to define optimal treatment protocols.
Limitations include significant heterogeneity between studies in terms of acupuncture protocols, populations studied, and methodologic quality. Only 15 of the 27 studies reported live birth rates, limiting analysis of this crucial outcome. In addition, variation in the acupuncture points used and in the timing of application complicate specific treatment recommendations.
Strengths
- 1Largest systematic review on acupuncture and IVF performed to date
- 2Robust meta-regression analysis identifying modifying factors
- 3Rigorous methodology with study quality assessment
- 4Clear identification of subgroups that benefit most from treatment
Limitations
- 1Significant heterogeneity in the acupuncture protocols used
- 2Only 55% of studies reported live birth rate
- 3Possible publication bias detected in smaller studies
- 4Variation in methodologic quality of included studies
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Recurrent implantation failure in IVF is one of the most challenging clinical scenarios in reproductive medicine, and this meta-analysis of 6,116 women positions acupuncture as an adjuvant with a clinically relevant benefit profile precisely in this population. The 21% increase in clinical pregnancy rate in the overall group already justifies discussing it with the patient, but it is the subgroup with previous repeat cycles that changes the therapeutic equation: 60% increase in clinical pregnancy and 42% in live birth rate are striking numbers for a low-risk adjuvant. In the practice of an assisted reproduction clinic, this means that acupuncture takes on a preferential indication precisely for the patient who is hardest to counsel — the one who has already tried two or three times without success and asks what else can be done. Integration with the controlled ovarian stimulation protocol is logistically simple and does not interfere with the other pillars of treatment.
▸ Notable Findings
The most robust finding of this analysis is not the overall result but the discovery that the proportion of repeat IVF cycles explained 100% of the between-study heterogeneity for clinical pregnancy rate — which transforms a discussion about average efficacy into a discussion about patient selection. In other words, studies that predominantly included women with prior attempts showed consistent benefit; studies in IVF-naive patients diluted the signal. The second notable finding is the dose-response role of session number: multiple sessions yielded an RR of 1.60 compared with a single session, and this parameter explained 51.9% of the observed heterogeneity. The proposed mechanism — modulation of the hypothalamic-pituitary-ovarian axis, improvement in uterine perfusion, and neuroendocrine reduction of stress — is consistent with what we know about how chronic stress impairs endometrial receptivity in repeat cycles.
▸ From My Experience
In my practice, when a couple presents after two unsuccessful IVF cycles, the hyperactivation of the stress axis is already clinically visible — and this is precisely where I have seen acupuncture add value most consistently. I typically start the protocol about eight weeks before embryo transfer, with weekly sessions, and I notice subjective improvement in anxiety and sleep quality within the first three or four sessions — which, in itself, already has measurable neuroendocrine impact. For the reproductive outcome itself, the data from this article are consistent with what I observe: patients who complete six to eight sessions over the course of the cycle tend to have better uterine receptivity documented on ultrasound and report a greater sense of control over the process. I do not recommend acupuncture as a substitute for further workup — Asherman syndrome, tubal factor, and embryonic genetic issues need to be ruled out first. But as an adjuvant in recurrent implantation failure without identified structural cause, it is now part of my routine protocol.
Full original article
Read the full scientific study
BMC Complementary and Alternative Medicine · 2019
DOI: 10.1186/s12906-019-2523-7
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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