While many people may be familiar with acupuncture, often they do not know what in particular makes it potentially effective as a treatment. Acupuncture involves small needle insertion into specific points of the body called acupuncture points, which are believed to stimulate different aspects of the nervous and endocrine systems.ⁱⁱ It is a clinically accepted therapy for the treatment of numerous conditions, including back painⁱⁱⁱ and osteoarthritis.^iv  

People also seek acupuncture for the improvement of reproductive health. It has been shown to provide potentially effective treatment for women’s reproductive disorders, including dysmenorrhea^v and premenstrual symptoms.^vi  Acupuncture may improve female reproductive health by increasing blood flow to the uterus and ovaries,^vii regulating levels of fertility hormones,^viii and influencing beta-endorphin production which could help patients with PCOS.^ix

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How does acupuncture improve fertility?

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There are many suspected mechanisms of action as to how acupuncture is believed to improve female fertility. Acupuncture research is more often focused on final outcomes rather than how it works (mechanism of action). Therefore, it is often not clear how acupuncture affects the physiology of the body. What is known about some of these mechanisms is discussed here.

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‍Female Fertility

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Optimal levels of FSH, LH, and estradiol are important in the regulation of the female uterine (menstrual) cycle and to IVF success. There is evidence supporting the idea that acupuncture treatment can lower FSH and LH levels, as well as increase estradiol levels in women with premature ovarian insufficiency.^x  

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Reviews of the published literature report that acupuncture can modulate hormones, such as estrogen, progesterone, and prolactin in individuals with gynecological or reproductive issues.  Researchers conclude that the neuroendocrine system (nervous and hormonal system) can be impacted by acupuncture treatment and that more research in this area is warranted.^xi

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Acupuncture is also believed to affect female fertility based on its action on the endometrium (uterine lining). Acupuncture has been associated with improvement in endometrial receptivity as well as improvement in endometrial morphology, by promoting microcirculation inside the uterus, as well as by regulating progesterone levels and receptor expression.^xii When used for individuals with poor endometrial receptivity, the positive impact appeared to increase with an increasing number of acupuncture sessions (i.e., weekly sessions for three menstrual cycles vs two acupuncture sessions).^xiii These improvements, however, have not reliably resulted in improved pregnancy or live birth rates.

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Male Fertility

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Abnormal levels of FSH and LH in males can decrease male fertility, by altering testosterone levels, spermatogenesis, or even impacting the seminiferous tubule lining (epithelium) and mesynchymal cells.^xiv Animal studies have suggested that acupuncture can potentially shift hormone levels in males by helping to reduce FSH and LH, and to increase testosterone levels.^xv,xvi However, it is unclear whether this effect is applicable to humans.  

Furthermore, acupuncture may improve fertility in those with male factor fertility related to sperm parameters.^xvii There is evidence to support the idea that sperm concentration, density, morphology, viability, and motility of sperm is significantly higher after acupuncture treatment in males with low sperm counts.^xviii,xix It is hypothesized that acupuncture may be causing these improvements via increased testicular blood flow and/or reducing genital inflammatory reactions by promoting a more balanced immune system. However, the mechanism of action related to improving sperm parameters remains unclear and these improvements do not necessarily result in higher pregnancy or live birth rates.^xx

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Acupuncture for fertility: research evidence

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Acupuncture became much more popular in the North American fertility market in 2009 after a small study published in the journal of Fertility and Sterility showed an increase in pregnancy rates in those who had acupuncture before and after in vitro fertilization (IVF) transfer.^xxi This study was criticized for not having a type of control arm called a "sham treatment”. In general, sham treatments are used in studies to ”blind” patients from knowing whether they are in the treatment or control arm of the study. Sham treatments can be designed where patients receive acupuncture at non-treatment points, or sham needles that do not penetrate skin, but feel like typical acupuncture treatment, are used.^xxii The same researchers later presented results from a prospective study using a sham control arm, showing no significant difference in clinical pregnancy rates between the acupuncture and sham groups.^xxiii The authors noted that the sham acupuncture treatments may still be offering some benefit and that the difficulty in assessing acupuncture effectiveness may be the lack of a good type of control arm in studies.^xxiv Since 2009, there has been research of varying quality to assess the role of acupuncture in both male and female fertility, which we discuss here.  

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Acupuncture for female fertility: research evidence and success rates

It is difficult to determine the efficacy of acupuncture for fertility because of the conflicting study results, small sample sizes, and heterogeneity in study methodologies (e.g.., different fertility conditions, patient populations, etc.). The more recent published scientific evidence available is summarized below.

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A 2019 systematic review and meta-analysis by Zhong and colleagues showed that acupuncture may slightly improve pregnancy rates, increase the likelihood of a trilaminar uterine lining (triple-line pattern) on ultrasound, and slightly thicken endometrium.^xxv Although these were statistically significant findings, the quality of research they analyzed was considered to be low.^xxvi Furthermore, the studies included had a variety of different control arms, making comparison difficult across studies.  

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A much larger 2021 review analyzed previous systematic reviews and published randomized control trials (RCTs) and noted that the reliability of previously published study results is poor because the overall quality of studies and reviews was very low.^xxvii They concluded that the evidence to support acupuncture in IVF and embryo transfer cycles is insufficient, but that nonetheless it appears that acupuncture may be able to increase the clinical pregnancy rate in women undergoing embryo transfers.^xxviii

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Another systematic review involving eight RCTs with 3,607 women assessed acupuncture around the time of embryo transfer.^xxix They found no statistically significant difference in acupuncture treatment versus placebo acupuncture with respect to clinical pregnancy rates or live birth rates.^xxx

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One well-conducted randomized controlled trial of 824 women undergoing IVF in Australia and New Zealand compared a sham treatment to acupuncture treatment with points to stimulate blood flow to the uterus, to inhibit central nervous system outflow and to inhibit biological stress response.^xxxi The Sham treatment used the Park device, whereby the control group receives non-insertive acupuncture using the Park sham needle, which does not penetrate the skin.^xxxii They found no significant difference in those receiving acupuncture treatments versus sham treatment; live birth rates were not significantly different in the acupuncture group (three treatments) versus the control (sham) group.^xxxiii

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Poor Ovarian Reserve. Research on acupuncture in those with poor ovarian reserve is limited. One pilot randomized controlled trial (RCT) by Kim et al (2020) showed that acupuncture before IVF treatment had beneficial effects in patients with a diagnosis of poor ovarian response. However, there were only 18 patients and it was a non-blinded RCT, so the reliability of results is unclear.^xxxiv A review by Jang et al (2020) analyzed three RCTs involving acupuncture treatment in poor responders undergoing IVF.^xxxv The authors observed improvements in several fertility parameters; however, the data was limited, and the authors note that it is difficult to conclude that IVF with acupuncture is more effective than IVF without acupuncture. Among the three RCTs reviewed, authors found improvements in clinical pregnancy rate, AMH (Anti Mullerian Hormone), AFC (antral follicle count), and number of retrieved oocytes.^xxxvi

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Recurrent Implantation Failure. There is also limited data on the effects of acupuncture in patients with recurrent implantation failure (RIF). A 2021 meta-analysis of patients with RIF showed that endometrial thickness and clinical pregnancy rate were improved in the acupuncture treatment group compared to the control groups.^xxxvii However, the authors note caution in the reliability of the results due to the lower quality of the studies included.^xxxviii

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PCOS. Usage of acupuncture in patients with PCOS also has mixed evidence in studies of varying degrees of quality.^{xxxix,xl,xli,xlii} As such, the efficacy of acupuncture on pregnancy outcomes in PCOS patients is unclear, with some studies showing improvement and others showing no improvements in outcomes. A 2019 systematic review and meta-analysis of eight RCTs comprising 1,546 women concluded that the evidence was not sufficient to determine the effectiveness of acupuncture for PCOS.^xliii

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Acupuncture for male fertility: research evidence and success rates

The first known study of acupuncture outside of Asia on male fertility was conducted in 1984 by Riegler and colleagues,^xliv which observed some improvement in sperm parameters. Since this time, however, various studies have been conducted to assess the effects of acupuncture on semen parameters with mixed results.

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In a 2021 systematic review and meta-analysis of seven studies with 527 subjects, acupuncture did not improve sperm parameters in those with reduced sperm motility (asthenospermia) and low sperm count (oligospermia).^xlv The authors suggested that due to poor research quality, they could not conclude that acupuncture was helpful in improving sperm quality.^xlvi

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Another review examined four randomized controlled trials and observed some improvement in sperm motility and concentration.^xlvii However, the authors noted that the evidence was not sufficient to support acupuncture as a treatment option for semen improvement due to inconsistency in studies, insufficient evidence due to few studies, high risk of bias, and poor quality of tracking outcomes.^xlviii  

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In sum, despite numerous studies investigating acupuncture and infertility (in both females and males), it is unclear whether acupuncture provides any benefit for patients undergoing fertility treatment. It is not difficult to see that there are many limitations in current studies on acupuncture treatment of infertility or improvement of fertility. For example, some studies lack control arms, many have small sample sizes, and lack a sufficient number of treatments, which results in insufficient conclusions.^xlix

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Acupuncture success rates for natural conception

A small study of 56 women in Australia compared those using lifestyle modifications to improve chances of conception versus those who also used acupuncture. They found that acupuncture positively influenced the women who received it compared to the women who used lifestyle modification alone. It increased their fertility awareness, improved their feelings of well-being, and decreased the time to pregnancy. More specifically, those who conceived did so in half the time (5.5 weeks) compared to those who only modified their lifestyle (10.67 weeks); however, this was not statistically significant and a difference of one month is equally likely due to physiological differences or chance, as opposed to treatment intervention.^l

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Risks of acupuncture for fertility

One study in the British Medical Journal reported that acupuncture can be considered safe.^li Serious adverse events are rare at a rate of 1.01 per million treatments, and potentially include pneumothorax, fainting, and falling.^lii The most common minor adverse events are very mild, such as bleeding, pain or flare at the needle site, as well as hematomas (bruises).^liii,^liv

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Where to get acupuncture for fertility

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Any healthcare provider licensed to do acupuncture in general could in theory treat infertility patients with a specific fertility methodology, but it is important to seek treatment with someone with experience. Acupuncture is often discussed at fertility clinics, and they may have people onsite who can perform acupuncture. Naturopathic doctors who provide acupuncture may also discuss diet and supplements to help with fertility. In addition to acupuncture, other traditional Chinese medicine (TCM) practices such as herbal remedies and dietary recommendations may be offered alongside acupuncture. By considering all of these aspects, couples and individuals can determine whether acupuncture and related treatments may be worth exploring in their fertility journey.

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Conclusion

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For those looking for an alternative form of treatment for fertility issues or an add-on to Assisted Reproductive Technology (ART) treatment, acupuncture may be worth considering. Despite not being a guaranteed solution, having limited evidence, and mixed results, acupuncture has helped some of those pursuing improved fertility outcomes achieve positive results. However, according to European Society of Human Reproduction and Embryology (ESHRE), acupuncture is not a recommended add-on treatment for IVF, given the lack of evidence to support its effectiveness^lv At the same time, acupuncture has minimal risks associated with it, especially if performed by a licensed and experienced practitioner, though it should not be considered as the sole form of fertility treatment. Those who are interested in exploring acupuncture as part of a fertility treatment plan should consult with a healthcare provider to ensure it is safe and right for that individual.

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