Association between acupuncture and IVF outcomes in women with poor ovarian response: a retrospective cohort study

Poor ovarian response (POR) is a major barrier to in vitro fertilization (IVF) success. We assessed whether adjunctive acupuncture is associated with improved IVF outcomes among women with POR.

We conducted a retrospective cohort study of women with POR undergoing IVF at Sichuan Jinxin Xi'nan Women's and Children's Hospital (1 January 2020-31 October 2024). Patients selected acupuncture (typically three sessions per week from ovarian stimulation through the day of embryo transfer) or no acupuncture in either acupuncture group or control group. The primary endpoint was the number of oocytes retrieved. The secondary endpoints included the clinical pregnancy rate (CPR) and live birth rate (LBR). Subgroup analyses were conducted according to the acupuncture dosage (low-dose group: ≤4 sessions, high-dose group: >4 sessions).

A total of 2,133 women with POR were included (887 in the acupuncture group and 1,246 in the control group). The baseline demographic and clinical characteristics were comparable between the groups except for follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH), and the previous failure cycles, which were adjusted as covariates in multivariable logistic regression. Regarding the primary endpoint, the higher number of retrieved oocytes (median [Q1, Q3]) in the acupuncture group (4.0 [3.0, 7.0] versus 3.0 [1.0, 4.0], Standardized Mean Difference (SMD) = 1.7, 95% confidence interval (CI) [1.53-1.95], P < 0.001, acupuncture group vs. control group). Higher CPR was also obtained in the acupuncture group (20.74% vs. 15.73%, adjusted odds ratio (OR) = 1.2, 95% CI [1.2-1.3], P = 0.037). However, the difference in LBR between the two groups did not reach statistical significance (13.8% vs. 13.9%, P = 0.059, adjusted OR, 1.0, 95% CI [0.9-1.1], acupuncture group vs. control group). Subgroup analyses indicated that high-dose acupuncture resulted in significantly higher oocytes retrieved (5.00 [3.00, 7.00] vs. 4.00 [3.00, 6.00], adjusted SMD = 0.5, 95% CI [0.3-0.7] P < 0.001).

In this single-center retrospective cohort, acupuncture was associated with an increased number of retrieved oocytes among women with POR undergoing IVF. Causal inference is limited; randomized trials using standardized acupuncture protocols are warranted.