---
title: "IVF"
url: "https://acuiq.com/wiki/evidence/ivf"
updated: 2026-10-10
last_verified: 2026-10-09
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-09"
reading_minutes: 6
sources: 11
---

# IVF

_What the Cochrane review, the 2018 JAMA trial, later meta-analyses, ESHRE, NICE and the HFEA report on acupuncture alongside IVF._

A [2018 trial](https://doi.org/10.1001/jama.2018.5336) of 848 women at 16 IVF centres in Australia and New Zealand, published in JAMA, found live births in 18.3% of women given acupuncture and 17.8% of women given a sham. That result matches the pattern across the systematic reviews: trials comparing acupuncture with no extra treatment have tended to report more pregnancies, and trials comparing it with a sham have not. The [2013 Cochrane review](https://doi.org/10.1002/14651858.CD006920.pub3) found no evidence that acupuncture improves live birth or pregnancy rates in assisted conception. ESHRE, the European society for human reproduction and embryology, does not recommend acupuncture as an add-on to IVF. This page reports what each source found and what it compared acupuncture with.

## Where the question came from

A [2002 German trial](https://doi.org/10.1016/s0015-0282(01)03273-3) by Paulus and colleagues gave 80 women acupuncture for 25 minutes before and after embryo transfer and 80 women no extra treatment. Clinical pregnancy, a pregnancy sac seen on ultrasound six weeks after transfer, was found in 42.5% of the acupuncture group and 26.3% of the control group. A [2008 meta-analysis in the BMJ](https://doi.org/10.1136/bmj.39471.430451.BE) by Manheimer and colleagues pooled seven trials with 1,366 women in which acupuncture was given within a day of embryo transfer, against a sham or no extra treatment. It found higher rates of clinical pregnancy (odds ratio 1.65) and of live birth (odds ratio 1.91, from four trials), and called the evidence preliminary. In the three trials where the control group already had higher pregnancy rates, the benefit was smaller and not statistically significant.

## The Cochrane review

The Cochrane review, by Ying Cheong and colleagues and last updated in July 2013, included 20 randomised trials comparing acupuncture during assisted reproduction with no treatment, a placebo or a sham. Its main outcome was live birth, which it rated with GRADE, the standard scale of how far evidence can be trusted.

| Timing of acupuncture | Trials and women | Odds ratio for live birth (95% confidence interval) | Certainty |
| --- | --- | --- | --- |
| Around egg collection | 2 trials, 464 women | 0.87 (0.59 to 1.29) | Low |
| Around embryo transfer | 8 trials, 2,505 women | 1.22 (0.87 to 1.70) | Low |

An odds ratio of 1 means no difference, and both intervals include 1. The trials around embryo transfer disagreed with each other substantially. The review found no evidence of an effect on pregnancy or miscarriage rates, and no significant side effects.

## The 2018 trial

The JAMA trial, led by Caroline Smith at Western Sydney University, randomised 848 women having a fresh IVF cycle between 2011 and 2015. Women had one treatment on day 6 to 8 of ovarian stimulation and two around embryo transfer. The trial was single-blind, and the sham used a needle that did not pierce the skin, placed away from the acupuncture points. Live births were 74 of 405 with acupuncture and 72 of 404 with the sham, a relative risk of 1.02 (95% confidence interval 0.76 to 1.38). The authors concluded that the findings do not support acupuncture to improve live birth rates in IVF.

## Later reviews

A [2019 review](https://doi.org/10.1016/j.rbmo.2018.12.038) by Smith and colleagues of acupuncture around embryo transfer included 20 trials with 5,130 women and split them by control. Against no extra treatment, acupuncture was linked to more clinical pregnancies (risk ratio 1.32, 12 trials, 2,230 women) and live births (risk ratio 1.30, 9 trials, 1,980 women, with a confidence interval reaching 1.00). Against a sham there was no significant difference. The authors suggested that the sham may itself have effects, and that women with several previous IVF cycles or low baseline pregnancy rates might be worth studying separately.

A [2021 review](https://doi.org/10.1177/0964528420958711) by Coyle and colleagues at RMIT University took only trials using a non-penetrating placebo device: eight trials with 3,607 women. Acupuncture around embryo transfer made no significant difference to clinical pregnancy (risk ratio 0.99, 6 trials, 2,473 women, moderate certainty) or live birth (risk ratio 0.87, 4 trials, 1,835 women, high certainty). Adverse events, such as discomfort and bruising, were mild to moderate.

A [2025 review](https://doi.org/10.1016/j.ijnurstu.2025.105097) by Fu and colleagues at Chengdu University of Traditional Chinese Medicine pooled 42 trials with 7,400 participants, combining sham and no-treatment controls. It found higher biochemical pregnancy rates (an early pregnancy detected by a blood test; risk ratio 1.28) and clinical pregnancy rates (risk ratio 1.19), less pain during procedures and lower anxiety. It also found a higher rate of early miscarriage in the acupuncture groups (risk ratio 1.51) and advised caution on that account.

## What guidance says

ESHRE’s [2023 good practice recommendations on add-ons](https://doi.org/10.1093/humrep/dead184) reviewed acupuncture alongside Chinese herbal medicine and other complementary therapies. It counted at least 34 trials and about 25 systematic reviews of acupuncture in IVF with widely varying methods, found the evidence on live birth contradictory, and concluded: “Acupuncture, Chinese and herbal medicine and other complementary therapies are not recommended.” It also cites an HFEA patient survey in which acupuncture was the second most common IVF add-on in the UK. ESHRE’s [2023 guideline on unexplained infertility](https://doi.org/10.1093/humrep/dead150) states that acupuncture in women is probably not recommended, a conditional recommendation on low-certainty evidence.

In England, NICE’s [fertility guideline (NG257)](https://www.nice.org.uk/guidance/ng257/chapter/Advice-about-factors-that-can-affect-fertility), published in March 2026 to replace CG156, keeps a recommendation whose evidence dates from 2004: inform people concerned about their fertility that “the effectiveness of complementary therapies for fertility problems has not been properly evaluated, and that further research is needed before such interventions can be recommended.” The UK fertility regulator, the HFEA, rates laboratory and clinical add-ons on a traffic-light scale, and [its list](https://www.hfea.gov.uk/treatments/treatment-add-ons/) does not include acupuncture. The HFEA states that it does not regulate complementary therapies and that they are not usually offered in licensed clinics. [Clinical guidelines](/wiki/evidence/clinical-guidelines) sets these positions beside other bodies’ positions on acupuncture.

## What the reviews could not settle

The reviews agree that acupuncture beats no extra treatment more often than it beats a sham, and disagree on what that means. One reading is that the sham works too, through relaxation, attention or touch; another is that the no-treatment comparisons carry bias the sham trials remove. [Sham acupuncture](/wiki/research/sham-acupuncture) sets out why no sham is inert. The reviews could not show whether timing, number of sessions or particular groups of women, such as those with repeated failed cycles, change the result, and the 2025 review’s miscarriage finding has not been tested in a trial designed to look for it.

AcuiQ’s [IVF page](/symptoms/infertility-ivf) lists the protocols individual studies prescribed, each with its citation; the female infertility and recurrent implantation failure pages hold related studies. [Polycystic ovary syndrome](/wiki/evidence/polycystic-ovary-syndrome) covers the trials of acupuncture for ovulation and live birth outside IVF.

### Sources

1. Cheong YC, Dix S, Hung Yu Ng E, Ledger WL, Farquhar C, Acupuncture and assisted reproductive technology, Cochrane Database of Systematic Reviews 2013 — https://doi.org/10.1002/14651858.CD006920.pub3
2. Smith CA, de Lacey S, Chapman M, et al., Effect of acupuncture vs sham acupuncture on live births among women undergoing in vitro fertilization: a randomized clinical trial, JAMA 2018 — https://doi.org/10.1001/jama.2018.5336
3. Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K, Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy, Fertility and Sterility 2002 — https://doi.org/10.1016/s0015-0282(01)03273-3
4. Manheimer E, Zhang G, Udoff L, et al., Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis, BMJ 2008 — https://doi.org/10.1136/bmj.39471.430451.BE
5. Smith CA, Armour M, Shewamene Z, Tan HY, Norman RJ, Johnson NP, Acupuncture performed around the time of embryo transfer: a systematic review and meta-analysis, Reproductive BioMedicine Online 2019 — https://doi.org/10.1016/j.rbmo.2018.12.038
6. Coyle ME, Stupans I, Abdel-Nour K, et al., Acupuncture versus placebo acupuncture for in vitro fertilisation: a systematic review and meta-analysis, Acupuncture in Medicine 2021 — https://doi.org/10.1177/0964528420958711
7. Fu QW, Zhu SM, Chen J, et al., Acupuncture for women undergoing in vitro fertilization: an updated systematic review and meta-analysis with trial sequential analysis, International Journal of Nursing Studies 2025 — https://doi.org/10.1016/j.ijnurstu.2025.105097
8. ESHRE Add-ons working group, Good practice recommendations on add-ons in reproductive medicine, Human Reproduction 2023 — https://doi.org/10.1093/humrep/dead184
9. Guideline Group on Unexplained Infertility, Evidence-based guideline: unexplained infertility, Human Reproduction 2023 — https://doi.org/10.1093/humrep/dead150
10. National Institute for Health and Care Excellence, Fertility problems: assessment and treatment (NG257), advice about factors that can affect fertility, March 2026 — https://www.nice.org.uk/guidance/ng257/chapter/Advice-about-factors-that-can-affect-fertility
11. Human Fertilisation and Embryology Authority, Treatment add-ons with limited evidence — https://www.hfea.gov.uk/treatments/treatment-add-ons/