The Effect of Acupuncture in Women with Polycystic Ovary Syndrome Undergoing in vitro Fertilization: A Systematic Review and Meta-Analysis

Yi L, Zhang H, Tian T, Zhang Y, Lou Y, Li J, Liu C, Ma C, Liu P, Li R, Qiao J, Huang S, Yang R · Expert Reviews in Molecular Medicine · 2026 January

DOI 10.1017/erm.2026.10048

Critical Appraisal

Does this review establish that adding acupuncture improves pregnancy rates during IVF?

The review suggests a possible benefit for women with polycystic ovary syndrome, but does not establish a dependable treatment effect. Across 13 trials, the authors report a higher clinical pregnancy rate with acupuncture added to IVF care: risk ratio 1.29, with a 95% confidence interval of 1.14–1.46. This means a relative increase, not 29 additional pregnancies per 100 women. Pregnancy was assessed per embryo transfer, rather than per woman starting treatment. Although eight databases were searched, the reported weaknesses in randomisation and allocation concealment limit confidence. Most controls received no additional acupuncture, so the pooled result also does not isolate a needling-specific benefit over sham treatment.

Why does the reported live-birth benefit require checking against the original trials?

The live-birth analysis contains a consequential denominator inconsistency, making its reported benefit uncertain. Figure 4 combines four trials, but the Cui trial contributes denominators of 14 and 11—the pregnancy counts shown in Figure 3—rather than its embryo-transfer denominators of 30 and 29. Other trials use their transfer denominators. This appears to mix the chance of live birth once pregnant with the chance of live birth after transfer, which are different clinical questions. The underlying trial reports were not available for verification. Until the counts and outcome definitions are reconciled, the pooled live-birth estimate should not be treated as a reliable measure of benefit.

Does the lower ovarian hyperstimulation rate establish that acupuncture makes IVF safer?

The authors report fewer cases of ovarian hyperstimulation syndrome, a potentially important IVF complication, but this does not establish overall safety. Six trials involving 666 participants produced a pooled risk ratio of 0.64, with a 95% confidence interval of 0.47–0.87. This is a favourable signal, although the underlying trial-method concerns still limit reliance on it. Miscarriage and cycle cancellation results were inconclusive, rather than evidence of equivalent risks. Acupuncture-specific adverse effects were not systematically presented, and the proposed biological explanation was not demonstrated in these trials. The review therefore leaves both the reliability of complication prevention and the broader balance of benefits and harms unresolved.

Assessed 18 Sept 2026.

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Insights

Acupuncture increases the high-quality embryo rate, live birth rate, and clinical pregnancy rate while reducing the duration and dose of gonadotropin in PCOS patients undergoing in-vitro fertilisation.

The study methodology involved analyzing eight databases until April 1, 2024, to investigate randomized controlled trials on the effect of acupuncture on in-vitro fertilization in patients with polycystic ovary syndrome. This analysis screened trials where the patients received acupuncture treatments during the process. The results of the analysis of these thirteen randomized trials, involving over a thousand patients, demonstrated that acupuncture significantly improved the clinical pregnancy rate, the quality of embryos, and the live birth rate, while reducing the required amount of gonadotropin and its duration of use. Acupuncture also decreased the occurrence of ovarian hyperstimulation syndrome. However, no substantial differences were observed in the fertilization rate, the quantity of oocytes, the thickness of the endometrium, specific hormonal levels, miscarriage rate, or the rate of cycle cancellation.