Timing and dose of acupuncture as adjuncts to assisted reproduction: a meta-analysis and model-based network meta-analysis.

OBJECTIVE

Acupuncture is widely used as an adjunct to assisted reproductive technology (ART), but its effects and the influence of treatment timing, modality, and dose remain uncertain. This study evaluated acupuncture-related interventions in ART and explored potential timing- and dose-response patterns.

METHODS

PubMed, Embase, Web of Science, Scopus, the Cochrane Library, and Ovid MEDLINE were searched from inception to January 19, 2026, with additional screening of eligible study and review reference lists. Randomized controlled trials of women undergoing in vitro fertilization, intracytoplasmic sperm injection, or embryo transfer were included when manual acupuncture, electroacupuncture, or transcutaneous electrical acupoint stimulation was used as an adjunctive ART intervention. Pairwise random-effects meta-analysis estimated overall effects; network meta-analysis compared intervention timing, modality, and needle-retention time; and model-based network meta-analysis examined dose-response associations by treatment sessions. Risk of bias was assessed using RoB 2, and certainty of evidence was rated with GRADE.

RESULTS

Forty-two trials including 9,390 women were included. Acupuncture was associated with higher clinical pregnancy rate [risk ratio (RR) = 1.25; 95% confidence interval (CI), 1.14-1.37] and implantation rate (RR = 1.16; 95% CI, 1.02-1.31), whereas the effect on live birth was uncertain (RR = 1.14; 95% CI, 0.98-1.32). Certainty of evidence for all overall major outcomes was very low. Timing analyses suggested higher estimates for acupuncture during controlled ovarian hyperstimulation, or during both controlled ovarian hyperstimulation and embryo transfer, than for acupuncture limited to embryo transfer; however, timing was closely correlated with cumulative treatment sessions, and these findings should be interpreted as exploratory. Dose-response models suggested possible nonlinear associations between treatment sessions and reproductive outcomes, but these model-based estimates were limited by sparse data, clinical heterogeneity, and model uncertainty and should not be used as treatment-dose recommendations.

CONCLUSIONS

Acupuncture as an adjunct to ART may improve clinical pregnancy and implantation rates, although the certainty of evidence is very low. The observed timing- and dose-response patterns provide exploratory, hypothesis-generating evidence regarding potentially beneficial treatment strategies but are insufficient to establish the superiority of a specific timing or number of sessions. Further well-designed trials are needed to confirm these findings.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk, identifier CRD420261291016.