In vitro fertilization (IVF) is one of the most demanding medical procedures from an emotional and physical standpoint. Daily gonadotropin injections, frequent ultrasound monitoring, oocyte retrieval under sedation, and embryo transfer make up a protocol that extends over weeks and imposes a significant burden on the well-being of patients. Consistent evidence demonstrates that elevated anxiety during the IVF cycle is associated with lower implantation rates, higher rates of treatment discontinuation, and worse quality of life during the assisted reproduction process.
A retrospective study conducted by University Hospitals Connor Whole Health and UH Fertility Center, in collaboration with Case Western Reserve University School of Medicine, analyzed 1,896 sessions of integrative treatment in 146 patients across 202 embryo transfer cycles between 2019 and 2022. Published in June 2025 in Global Advances in Integrative Medicine and Health, the study generated broad U.S. média coverage and represents one of the largest data series on acupuncture integrated into IVF at a Western academic center.
ACUPUNCTURE INTEGRATED INTO IVF — UNIVERSITY HOSPITALS CLEVELAND
Study design and population
This is a retrospective analysis of prospectively collected data at one of the largest university fertility centers in the United States. The patients were treated in the integrative medicine program at UH Connor Whole Health, integrated into the assisted reproduction protocol of UH Fertility Center. Treatments included medical acupuncture and complementary techniques of Traditional Chinese Medicine as part of a systematized protocol (Whole Systems Traditional Chinese Medicine — WS-TCM).
Symptoms of anxiety, stress, and pain were assessed before and after each session using 10-point numerical scales, allowing measurement of the acute effect of each individual treatment. In all, 1,896 sessions were analyzed. In 88.6% of IVF cycles, patients received treatment on the day of embryo transfer — the moment of greatest emotional and physical burden of the process. In 64.9% of cycles, treatment was also integrated in the weeks preceding the transfer, promoting preparation of the neuroendocrine system before the main procedure.
Results: acute and consistent reduction
The three outcomes evaluated showed clinically relevant reductions. Anxiety — the most prevalent symptom in the studied population — recorded a mean decrease of 2.2 points on a 10-unit scale, equivalent to a reduction of more than 20% of the baseline score. Stress showed a similar reduction of 2.1 points, and pain — relevant especially in the context of oocyte retrieval and progesterone injections — recorded a decrease of 1.4 points. These reductions were consistent across different treatment cycles, suggesting that the effect does not attenuate with repetition.
A particularly relevant finding is the mental health profile of the sample: more than 25% of patients had documented mental health diagnoses in the medical record, with anxiety being the most frequent diagnosis. This indicates that the population treated was not composed only of patients with mild situational stress, but included women with pré-existing psychiatric vulnerability — exactly the group that most benefits from non-pharmacologic complementary interventions during IVF.
INTEGRATION INTO THE IVF PROTOCOL
Context: why stress management matters in IVF
The relationship between psychological stress and reproductive outcomes is biologically plausible and clinically documented. Proposed mechanisms include that chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis during elevated stress leads to sustained release of cortisol, which interferes with GnRH pulsatility, endometrial receptivity, and oocyte quality. Prospective studies have associated patients with higher anxiety scores before embryo transfer with significantly lower implantation rates. Therefore, reducing anxiety during IVF is not a secondary comfort objective — it is a strategy potentially relevant for procedure success.
In this context, medical acupuncture presents an important advantage over pharmacologic alternatives: the most effective anxiolytics (benzodiazepines) are contraindicated during potential pregnancy, and antidepressants with anxiolytic action (SSRIs) carry teratogenic concerns in the first trimester. Acupuncture offers modulation of the HPA axis and autonomic nervous system without pharmacologic exposure — a feature particularly relevant in the peri-implantation period.
Frequently Asked Questions
This specific study did not evaluate pregnancy rate as an outcome — its focus was reduction of emotional and pain symptoms. However, previous meta-analyses (including studies with specific acupoints for endometrial receptivity) suggest benefit in implantation rates when acupuncture is performed in the peri-transfer period. The physician should explain to the patient that acupuncture has favorable evidence (although derived primarily from observational studies) for reduction of anxiety and stress, and suggestive (but not yet conclusive) evidence for increased pregnancy rates.
The protocol of this study included sessions over weeks before transfer (64.9% of cycles) and mandatorily on the day of transfer (88.6%). In practice, a typical protocol includes 1 to 2 sessions per week during the 2 to 4 weeks of hormonal stimulation, plus a pré-retrieval session and one on the day of transfer. The total number ranges from 6 to 10 sessions per cycle, depending on the IVF protocol and individual response.
Yes, and this study reinforces that practice: 88.6% of cycles included treatment on the day of transfer. The session typically occurs before and/or after transfer, in a calm environment near the assisted reproduction center. There is no known contraindication to performing acupuncture on the day of transfer, and the benefit on acute anxiety at that moment is especially relevant. The medical acupuncturist should coordinate timing with the reproductive medicine team.
Medical acupuncture does not use pharmacologic substances and does not directly interfere with the implantation process. In this study with 1,896 sessions and 202 transfers, no adverse events related to treatment were reported. Points classically considered contraindicated in pregnancy (such as certain abdominal and sacral points) are avoided as a precaution. The safety profile of acupuncture in the IVF context is favorable when practiced by a physician, with adverse events predominantly local and transient. Recent meta-analyses identified a signal of possible association with early miscarriage that still requires causal clarification.
Fonte Original
Global Advances in Integrative Medicine and Health(em inglês)Estudo Científico
DOI: 10.1177/27536130251349116Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).
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