Clinical efficacy of acupuncture for women with PCOS undergoing IVF/ICSI: a meta-analysis of randomized controlled trials.

Abstract / Summary

Infertility constitutes a critical global reproductive health issue, with its overall incidence exhibiting a substantial upward trend. Polycystic ovary syndrome (PCOS) is recognized as a predominant etiological factor in female infertility. Although accumulating clinical evidence suggests that acupuncture may exert therapeutic benefits in improving reproductive outcomes, existing findings remain inconsistent. Accordingly, this meta-analysis was conducted to systematically evaluate current randomized controlled trials (RCTs) and determine whether acupuncture improves clinical outcomes in infertile women with PCOS undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Relevant RCTs investigating the effects of acupuncture in infertile women with PCOS undergoing IVF/ICSI were identified through an exhaustive search of seven databases from inception to March 7, 2026. Forest plots were used to present the pooled evidence. The outcomes comprised one primary outcome and nine secondary outcomes. Risk of bias was appraised using the RoB 2.0 tool. Sensitivity analyses were performed to examine the stability of pooled estimates, while publication bias was assessed with Egger's and Begg's tests. Subgroup analyses were also conducted to evaluate differences in therapeutic effects on the primary outcome across acupuncture modalities, number of acupoints, and ovarian stimulation protocols. The certainty of the evidence was assessed utilizing GRADEpro GDT. Of the 551 initially identified articles, 22 RCTs encompassing 2,299 infertile women with PCOS undergoing IVF/ICSI were included. Meta-analysis demonstrated that acupuncture therapy was associated with a 13% increase in clinical pregnancy rate (CPR) (RD = 0.13, 95% CI: 0.09 to 0.17; p < 0.00001) and a 15% increase in live birth rate (RD = 0.15, 95% CI: 0.09 to 0.21; p < 0.00001), along with an increased number of optimal embryos (MD = 0.42, 95% CI: 0.17 to 0.66; p = 0.0009) and higher E2 on the day of hCG (SMD = 0.30, 95% CI: 0.07 to 0.53; p = 0.010). Additionally, a reduced total gonadotropin (Gn) dose (MD = -633.45, 95% CI: -1034.65 to -232.24; p = 0.002) and shorter duration of Gn use (MD = -0.74, 95% CI: -1.14 to -0.34; p = 0.0003) were observed in the acupuncture group. Acupuncture therapy was not associated with an increased incidence of ovarian hyperstimulation syndrome (RD = -0.03, 95% CI: -0.07 to 0.01; p = 0.11). Subgroup analysis further suggested that manual acupuncture was associated with a higher clinical pregnancy rate (25%) compared with electroacupuncture (10%). CPR was also higher in the GnRH antagonist protocol (21%) than in the GnRH agonist long protocol (11%) when combined with acupuncture. Sensitivity analyses indicated that the pooled evidence was robust. The overall quality of evidence for all outcomes ranged from very low to moderate. Evidence from 2,299 infertile women with PCOS suggests that acupuncture interventions may be associated with improved IVF/ICSI outcomes, although findings should be interpreted with caution due to the very low to moderate certainty of evidence. Further rigorous, multicenter studies with more standardized designs and training protocols are therefore warranted to confirm the efficacy of acupuncture in this population. https://www.crd.york.ac.uk, identifier CRD420261352381.

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