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

Abstract

Background: Acupuncture therapy has garnered significant attention for its potential role in enhancing the quantity and quality of oocytes retrieved and the number of embryos formed during in vitro fertilization (IVF) with controlled ovarian stimulation (COS).

Objective: This systematic review and meta-analysis evaluated the effectiveness of acupuncture for improving oocyte and embryo quality in IVF patients undergoing COS.

Search strategy: PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data, VIP Database and SinoMed were searched, from inception to 30 June 2025.

Inclusion criteria: Randomized controlled trials (RCTs) comparing IVF (with or without intracytoplasmic sperm injection) combined with acupuncture (manual acupuncture or electroacupuncture) to IVF alone or IVF with sham/placebo acupuncture in female infertility patients were included, without restrictions on race, age or nationality. Outcome variables included high-quality embryo rate (HQER), high-quality oocyte rate (HQOR), fertilization rate (FR) and the number of retrieved oocytes (ROs).

Data extraction and analysis: Data were analyzed using Review Manager 5.4.0. The primary outcome was HQER, and secondary outcomes comprised ROs, HQOR and FR.

Results: Eighteen studies were analyzed. Six studies showed that acupuncture significantly improved HQER (odds ratio [OR] = 1.76, 95% confidence interval [CI] [1.30, 2.39], P = 0.0003; moderate-certainty evidence) with moderate heterogeneity (I² = 49%). Two RCTs indicated that IVF combined with acupuncture was better than IVF alone for HQOR (OR = 2.39, 95% CI [1.42, 4.02], P = 0.001; low-certainty evidence) with substantial heterogeneity (I² = 69%). Four RCTs showed significant improvement in FR in the acupuncture group (OR = 1.47, 95% CI [1.19, 1.82], P = 0.0003; I² = 0%; moderate-certainty evidence). Subgroup analyses revealed that acupuncture increased oocytes retrieved in the follicle-stimulating hormone (FSH) ≥ 25 mIU/mL group (mean difference [MD] = 0.55, 95% CI [0.29, 0.82], P < 0.0001; I² = 38%; low-certainty evidence) and within 12-24 sessions (MD = 1.44, 95% CI [0.12, 2.76], P = 0.03; I² = 0%; low-certainty evidence).

Conclusion: Acupuncture is an effective adjunct therapy for improving embryo quality in assisted reproductive technology, which is supported by moderate-certainty evidence. Its efficacy is not uniform but follows two key principles: first, a patient-stratified effect, where increased oocyte yield is exclusive to women with high FSH (≥ 25 mIU/mL); and second, an outcome-dependent dosing, where embryo quality benefits from brief courses (5-8 sessions), while oocyte number requires longer regimens (≥ 12 sessions). This recommended a personalized acupuncture treatment regime for IVF, moving beyond a one-size-fits-all approach. Please cite this article as: Wang JY, Xu JB, Chen XL, Liu T, Shi D, Li WJ. Acupuncture to ensure high-quality embryos in women undergoing in vitro fertilization: A systematic review and meta-analysis. J Integr Med. 2026; Epub ahead of print.