Efficacy of acupuncture for recurrent implantation failure: a systematic review and meta-analysis of randomized...

Recurrent implantation failure (RIF) presents significant clinical and psychological challenges. While acupuncture is a potential adjunctive therapy during embryo transfer (ET), comprehensive evidence regarding its multidimensional effects remains limited. This study systematically evaluates acupuncture's impact on pregnancy outcomes, endometrial receptivity, and psychological status in RIF patients.

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing acupuncture + ET with ET alone in patients with RIF. Eight major databases were searched from inception through October 2025. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

Fourteen RCTs involving 1,428 patients were included. Regarding clinical efficacy, acupuncture + ET significantly increased the clinical pregnancy rate (relative risk [RR] = 1.73, 95% confidence interval [CI] [1.51, 1.99], p < 0.001), the embryo implantation rate (RR = 1.69, 95% CI [1.34, 2.13], p < 0.001), and the live birth rate (RR = 1.82, 95% CI [1.16, 2.86], p = 0.009), while reducing the miscarriage rate (RR = 0.40, 95% CI [0.17, 0.97], p = 0.04). In terms of endometrial receptivity, acupuncture significantly increased endometrial thickness (mean difference [MD] = 1.20, 95% CI [0.75, 1.66], p < 0.001) and reduced the endometrial pulsatility index (MD = -0.49, 95% CI [-0.93, -0.06], p = 0.03) and resistance index (MD = -0.21, 95% CI [-0.30, -0.13], p < 0.001). Furthermore, significant reductions in Self-Rating Anxiety Scale and Self-Rating Depression Scale scores were observed (MD = -5.89, p = 0.02 and MD = -6.83, p = 0.003, respectively). However, the certainty of evidence ranged from very low to moderate due to methodological limitations and high heterogeneity.

Acupuncture may be a promising adjunctive therapy for RIF patients undergoing ET. However, the current evidence is constrained by significant methodological limitations. These results support the clinical integration of acupuncture into multidisciplinary RIF management but should be further confirmed by multicenter, rigorously blinded trials with standardized protocols and long-term outcome assessments.

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1237224, the Unique Identifier is PROSPERO CRD420251237224.